Isthmian  Canal  Commission 


SANITARY  CONDITIONS  ON  THE 
ISTHMUS  OF  PANAMA 


REPLY  OF  THE 
ISTHMIAN  CANAL  COMMISSION 


TO    THE 


REPORT  OF  DR,  C.  A.  L,  REED 

WITH 

LETTERS  OF -THE  PRESIDENT  AND 
SECRETARY  OF  WAR 

IN  REFERENCE    THERBTO 


WASHINGTON,  D.  C. 
1905 


TABLE  OF  CONTENTS. 

1 .  Letter  of  the  Secretary  of  War  to  the  President  transmitt- 

ing the  reply  of  the  Isthmian  Canal  Commission  to  the 
report  of  Dr.  C.  A.  L.  Reed. 

2.  Letter  of  the  President  to  the  Secretary  of  War  in  reply 

thereto. 

3.  Letter  to  the  Chairman  of  the  Commission  from  the   Sec- 

retary of  War  transmitting  the  report  of  Dr.  Reed. 

4.  Letter  of  the  Isthmian  Canal  Commission  to  the  Secretary 

of  War  in  reply  to  Dr.  Reed. 

5.  Report  of  Dr.  C.  A.  L.  Reed  to  the  Secretary  of  War. 


t/,S. Isthmian  Canal  Commission 


SANITARY  CONDITIONS  ON  THE 
ISTHMUS  OF  PANAMA 


REPLY  OF  THE 
ISTHMIAN  CANAL  COMMISSION 


TO   THE 


REPORT  OF  DR.  C.  A.  L.  REED 

WITH 

LETTERS  OF  THE  PRESIDENT  AND 
SECRETARY  OF  WAR 

IN  REFERENCE   THERETO 


WASHINGTON,  D.  C. 
1905 


l^^ 


War  Department^ 
Washington^  D.  C,  March  17 ,  ^9^5- 
To  THE  President  : 

I  herewith  transmit  the  answer  of  the  Commission  to 
the  charges  contained  in  the  report  of  Dr.  C.  A.  L.  Reed, 
to  me  as  to  the  sanitary  provisions  made  by  the  Isthmian 
Canal  Commission  on  the  Isthmus. 

I  think  that  a  reading  of  the  two  documents  will  show 
what  indeed  was  apparent  on  the  face  of  Dr.  Reed's 
statement — that  his  charges  against  the  Commission 
were  biased  and  controversial,  and  not  written  in  the 
judicial  spirit  that  inspires  confidence  in  their  justice  and 
accuracy. 

Dr.  Reed  visited  the  Isthmus  at  my  request  to  act 
as  an  assessor  of  land  upon  a  commission  provided  by 
the  treaty  between  Panama  and  the  United  States,  but 
as  he  was  the  head  of  the  American  Medical  Association, 
it  seemed  to  me  an  opportunity  on  his  return  to  secure 
information  from  one  skilled  in  his  profession  as  to  the 
existing  conditions  upon  the  Isthmus.  In  response  to 
my  queries  he  was  so  emphatic  and  so  detailed  in  his 
charges  that  I  asked  him  to  make  his  statement  in  writ- 
ing, which  he  did  upon  the  same  day  by  the  use  of  a 
stenographer.  It  is  probable  that  had  he  taken  more  time 
he  would  have  been  more  measured  in  his  criticisms, 
less  extreme  in  his  statements,  and  less  flippant  in  his 
references  to  the  action  of  the  Commission.  The  report 
of  Dr.  Reed  was  published  without  my  knowledge  or 
consent. 

The  reply  of  the  Commission  seems  to  show  that  a 
large  part  of  the  plans  and  the  action  of  the  Commission 
which  Dr.  Reed  criticises  was  fully  concurred  in  and 


agreed  to  by  Colonel  Gorgas  and  the  other  medical  of- 
ficers in  the  employ  of  the  Commission.  It  is  doubtless 
true  that  Colonel  Gorgas  and  his  staff  believed  that  it 
would  be  wiser  to  give  them  an  entirely  free  hand  in 
the  matter  of  ordering  construction,  supplies  and  the 
employment  of  subordinates.  It  is  quite  probable  that 
had  the  approval  of  the  Commission  in  the  matter  of 
ordering  construction  and  supplies  been  dispensed  with 
there  would  have  been  fewer  delays  and  less  complaint 
on  this  account;  but  in  the  expenditure  of  such  large 
sums  as  were  necessary  for  the  organization  of  the  sani- 
tary system,  the  construction  of  plant  and  the  purchases 
of  supplies,  it  may  well  be  doubted  whether  the  Com- 
mission would  have  been  discharging  its  duty  in  with- 
holding supervisory  control. 

It  is  doubtless  true  that  there  have  been  undue  delays 
in  the  furnishing  of  what  was  needed  for  sanitary  pur- 
poses on  the  Isthmus,  but  I  venture  to  think  that  this  is 
due  rather  to  the  inherent  clumsiness  of  the  Commission 
as  an  executive  body  than  to  the  neglect  or  willful  non- 
action of  any  member  of  that  board.  There  must  be 
some  restraint  for  purposes  of  economy  upon  expendi- 
tures, by  an  executive  who  has  in  mind  the  total  expendi- 
tures and  obligations  being  incurred.  To  allow  each 
department  to  expend  what  in  its  judgment  is  necessary 
will  certainly  lead  to  extravagances  and  waste.  The 
remedy  for  the  delays  which  may  have  occurred  here 
are,  it  seems  to  me,  to  be  found  in  a  rearrangement  of 
the  Commission,  with  a  new  distribution  of  powers  and 
the  conferring  of  the  executive  on  one  or,  at  the  most, 
not  more  than  three  members  of  the  Commission,  with 
a  general  supervisory  and  confirmatory  power  in  the 
Commission  as  a  body. 

With  your  permission,  I  will  submit  in  a  day  or  two  a 
plan  for  the  better  carrying  on  of  the  work  of  the  Com- 


mission  which  may  be  embodied  in  a  new  series  of  in- 
structions. Respectfully  yours, 

Wm.  H.  Taft^ 
Secretary  of  War. 

White  House, 
Washington,,  March  20,  1905- 
The  Secretary  of  War  : 

I  have  received  your  report  of  March  17th,  together 
with  the  report  of  Dr.  Reed  and  the  answer  thereto  made 
by  the  Commission.  It  appears  from  this  that  Dr.  Reed's 
report  (which,  of  course,  should  under  no  circumstances 
have  been  given  to  the  public  until  you  chose  so  to  give 
it,  and  until  the  answer  thereto  had  been  made  by  the 
Commission)  was,  without  your  knowledge,  printed  in 
the  medical  journals. 

It  further  appears  that  the  statements  which  he  thus 
published  were  in  many  instances  unwarranted  by  the 
facts,  and  his  accusations  in  many  instances  unsupported 
by  proof. 

Dr.  Reed  has  not  displayed  in  this  report  the  qualities 
of  temperament  or  the  power  of  accurate  judicial  obser- 
vation needed  to  make  a  report  valuable  to  the  Govern- 
ment. It  is  true  that  he  was  not  charged  with  the  duty 
of  making  such  a  report,  and  that  he  was  appointed  to 
be  a  commissioner  to  assess  value  of  real  estate.  Never- 
theless, when  he  assumed  to  make  a  report  on  sanitary 
conditions  at  your  request  as  Secretary  of  War,  he  was 
under  obligation  to  speak  with  care  and  justice  on  so 
important  a  subject  and  to  observe  the  proprieties  as  to 
its  publication. 

Judging  from  your  report,  it  appears  that  the  chief 
difficulties  that  have  arisen  have  come  from  the  inherent 
faultiness  of  the  law  under  which  the  Commission  was 
appointed.    It  further  appears,  however,  that  in  view  of 


6 

our  experience  with  the  workings  of  the  Commission,  a 
rearrangement  of  duties  and  a  change  of  personnel  in 
view  of  this  rearrangement  should  be  made.  I  am  glad 
that  you  are  shortly  to  submit  to  me  a  plan  with  these 
objects  in  view. 

Theodore  Roosevelt. 

War  Department, 
Washington,  March  6,  1903. 
(confidential.) 
My  Dear  Admiral  : 

I  enclose  herewith  a  report  made  to  me  by  Dr.  C.  A.  L. 
Reed,  one  of  the  Commissioners  whom  the  President 
appointed  to  assess  property  on  the  Isthmus. 

Dr.  Reed  is  the  president  of  the  American  Medical 
Association,  and  as  such  took  much  interest  in  the  sani- 
tary provisions  for  meeting  the  dangers  from  disease  in 
Panama.  He  has  accordingly  written  this  report.  It 
is  so  extreme  in  many  of  its  statements  that,  though  I 
should  place  it  on  my  confidential  files  only,  I  feel  that 
in  justice  to  your  Commission  even  there  it  should  be 
accompanied  by  such  comment  as  your  Commission 
might  desire  to  make  upon  it.  The  bias  of  Dr.  Reed  is 
evident  in  the  tone  of  the  letter,  but  he  makes  a  number 
of  statements  of  fact  which  it  is  possible  you  or  some 
member  of  the  Commission  may  desire  to  controvert, 
and  which  certainly  you  ought  to  have  an  opportunity  to 
deny  if  existing  conditions  justify  and  require  it. 

Very  sincerely  yours, 

Wm.  H.  Taft. 
Rear- Admiral  John  G.  Walker,  U.  S.  N.  (Retired), 
Chairman,  Isthmian  Canal  Commission. 
(enclosure.) 
P.  S. — I  ought  to  have  said  that  I  showed  this  report 
to  the  President,  and  that  any  answer  which  it  may  be 
thought  wise  to  make  to  it  will  also  be  submitted  to  him. 


K^- 


March  i6,  1905. 
The  Hon.  Wm.  H.  Taft^  Secretary  of  War. 

Sir: — The  Commission  has  given  such  consideration 
to  the  letter  addressed  to  you  under  date  of  March  2, 
1905,  by  Dr.  C.  A.  L.  Reed  as  time  that  could  be  spared 
from  the  urgent  duties  of  the  office  since  its  receipt  on 
March  7th  has  permitted. 

The  letter  is  so  full  of  misstatements  that  it  has  been 
thought  advisable  to  answer  it  at  considerable  length, 
even  though  the  tone  thereof  should  be  sufficient  evi- 
dence that  it  is  the  product  of  a  strangely  biased  mind. 

The  Health  Department  was  preliminarily  organized 
in  May,  1904,  a  few  days  after  the  canal  properties  came 
into  possession  of  the  United  States. 

The  permanent  organization  of  this  department  was 
under  consideration  during  the  stay  of  the  Commission 
on  the  Isthmus  in  the  summer  of  1904,  during  all  of 
August,  having  been  adopted  on  September  2d.  Com- 
missioner Grunsky  took  a  special  interest  in  the  affairs 
of  the  Health  Department  and  the  sanitary  work  on  the 
Isthmus,  and  assisted  the  Medical  Staff  in  planning  the 
permanent  organization,  being  in  frequent  conference 
with  the  physicians  and  submitting  to  the  Commission 
the  result  of  the  deliberations.  It  was  at  once  apparent 
to  the  Commission  that  it  would  not  be  possible  to  accept 
in  their  entirety  the  recommendations  and  suggestions 
made  by  the  Chief  Sanitary  Officer,  which  included  such 
matters  as  the  immediate  taking  over  and  management 
by  the  United  States  of  the  San  Tomas  Hospital,  one  of 
the  public  institutions  of  the  Republic  of  Panama,  lo- 
cated in  Panama;  the  taking  over  and  management  of 
the  poorhouse  of  Panama  called  Asilo  de  Bolivar;  the 
taking  over  of  the  Lazaretto,  or  home  of  lepers. 

Dr.  Reed's  assertion  that  "much  of  the  report  on  a 
plan  of  organization  was  formulated  over  the  respectful 


8 


protest  of  the  medical  men"  is  without  any  foundation 
whatever.  Modifications  of  the  suggestions  submitted 
by  the  Medical  Staff  were  made  from  day  to  day  until  a 
plan  acceptable  to  both  the  Commission  and  to  the 
Medical  Staff  was  worked  out  which  must  stand  on  its 
merits.  It  may  at  once  be  stated  that  one  of  its  chief 
merits  lies  in  its  elasticity. 

The  facilities  immediately  provided  and  to  be  provided 
were  those  foreseen  to  be  necessary  within  the  time 
during  which  plans  of  the  canal  were  to  be  under  consid- 
eration, and  during  which  there  would  be  only  a  mod- 
erate force  at  work  on  actual  canal  construction. 

In  order  that  the  character  of  modifications  of  the 
scheme  as  submitted  by  the  chief  sanitary  officer  may 
be  understood,  one  illustration  may  suffice.  He  had  sug- 
gested the  establishment  and  equipment  of  twenty  emer- 
gency hospitals  (these  being  apart  from  the  hospitals 
at  Ancon  and  Colon),  with  twenty  beds  each  and  the 
necessary  staff  of  employes,  to  be  located  along  the  line 
of  the  canal ;  that  is,  one  every  two  miles  between  Pan- 
ama and  Colon.  Without  venturing  to  pass  upon  the 
ultimate  necessity  for  this  number  of  emergency  hos- 
pitals, it  was  decided  that  it  would  be  better  to  establish 
only  three  at  the  outset,  each  with  less  than  twenty  beds. 
These  were  to  be  located  at  centers  of  population  and 
to  be  enlarged,  and  others  were  to  be  established  and 
equipped  as  should  later  be  found  necessary. 

The  following  from  the  report  on  the  plan  of  organi- 
zation refers  to  this  matter : 


"Emergency  hospitals  will  be  required  along  the  line 
of  the  canal  as  soon  as  large  numbers  of  laborers  are 
concentrated  at  the  points  where  the  work  is  of  greatest 
magnitude.  At  each  of  these  hospitals  a  physician  should 
be  stationed.     Each  emergency  hospital  should  be  suit- 


9 

ably  equipped  for  emergency  service  and  should  have 
combined  v^ith  it  a  dispensary. 

"It  is  assumed  by  the  Chief  Sanitary  Officer  that  there 
will  be  need  ultimately  for  twenty  of  these  hospitals, 
with  twenty  beds  each,  but  after  careful  consideration  of 
the  matter  it  was  decided  that  necessity  does  not  exist 
for  more  than  three  at  present,  and  that  others  can  be 
added  as  required." 

Other  modifications  of  the  submitted  scheme  of  a  like 
character  were  made  in  a  like  spirit,  and  in  every  case  the 
matter  involved  was  fully  discussed  with,  and  concurred 
in,  by  the  Medical  Staff. 

The  joint  participation  of  all  the  Commissioners  in 
the  formulation  of  the  plan  of  organization  is  sufficiently 
evidenced  by  the  adoption  of  the  report  upon  this  matter 
without  modification.  The  organization  of  the  Depart- 
ment of  Health,  as  perfected,  except  possibly  the  Board 
of  Health  feature,  which  originated  with  the  Commis- 
sion's general  counsel,  seemed  to  be  highly  satisfactory 
to  the  Chief  Sanitary  Officer  and  his  associates,  and  met 
with  their  entire  and  full  concurrence. 

The  spirit  which  pervades  the  plan  of  organization  is 
well  illustrated  in  the  first  paragraph  of  the  report  there- 
on, which  was  subsequently  adopted. 

''After  repeated  conferences  with  the  Chief  Sanitary 
Officer,  Dr.  Gorgas ;  Director  of  Hospitals,  Dr.  Ross; 
the  Superinendent  of  Ancon  Hospital,  Dr.  LaGarde ; 
Chief  Quarantine  Officer,  Dr.  Carter;  Chief  Sanitary  In- 
spector of  the  Canal  Zone,  Mr.  LePrince;  the  Superin- 
tendent of  Colon  Hospital,  Dr.  Spratling,  and  the  Super- 
vising Architect,  Mr.  Johnson,  it  has  been  agreed  to  be 
desirable  to  perfect  an  organization  of  the  Department 
of  Health  as  herein  set  forth,  which  will  be  sufficiently 
elastic  to  permit  of  expansion  or  contraction  as  condi- 
tions on  the  Isthmus  may,  from  time  to  time,  require. 
The  needs  of  the  first  year  of  service  and  the  conditions 


lO 


prevailing  during  the  time  of  preparation  for  canal  work 
on  a  large  scale  were,  therefore,  used  as  a  guide  in  de- 
termining the  scope  of  the  work  to  be  done  and  the  per- 
sonnel which  should  be  authorized." 

As  Dr.  Reed  comments  unfavorably  upon  the  Commis- 
sion's Department  of  Material  and  Supplies,  it  should  be 
briefly  stated  that  this  department  was  created  for  the  pur- 
pose of  receiving,  storing,  caring  for  and  issuing  supplies 
and  materials,  including  those  for  the  medical  department 
and  for  the  care  of  machinery  not  in  use.  It  naturally 
works  in  conjunction  with  the  Commission's  Purchasing 
and  Shipping  Department.  Dr.  Reed  says  that  in  the 
resolution  creating  the  Material  and  Supplies  Depart- 
ment nothing  is  said  about  the  Sanitary  Department, 
thereby  giving  the  impression  that  by  some  oversight 
a  right  of  inspection  accorded  other  departments  has 
been  denied  to  the  Sanitary  Department  as  such,  and 
that  the  Health  Department  will  be  hampered  in  secur- 
ing suitable  medicines  and  supplies.  Dr.  Reed  should 
liave  continued  his  quotation  by  adding  the  following, 
which  appears  in  the  printed  proceedings  of  the  Com- 
mission's meeting  of  August  28,   1904: 

**In  the  organization  of  a  general  purchasing  depart- 
ment provision  could  well  be  made  for  at  least  one  com- 
petent clerk  who  is  familiar  with  the  requirements  of 
sanitary  and  hospital  service.  Purchases  of  medical  sup- 
plies and  instruments  could  be  just  as  carefully  made  as 
through  an  independent  office.  All  supplies  and  medical 
stores  should  be  consigned  to  the  general  storekeeper 
of  the  Commission,  and  should  by  him  be  at  once  trans- 
ferred to  a  sub-department  and  possibly  a  separate  store- 
house, where  they  could  be  kept  apart  from  other 
-stores." 

The  Commission,  in  the  making  of  its  first  purchase 


II 


for  the  Health  Department,  gave  the  Medical  Staff  au- 
thority to  purchase  in  open  market  whatever  was  neces- 
sary. In  the  making  of  subsequent  purchases  it  called 
upon  Colonel  Turrell,  Medical  Purveyor,  U.  S.  A.,  at 
New  York,  for  assistance,  chiefly  with  a  view  to  the  is- 
suance of  clear  specifications  for  supplies  and  medicines, 
and  still  later  an  arrangement  was  made  with  Surgeon- 
General  Wyman,  of  the  United  States  Public  Health 
and  Marine  Hospital  Service,  under  which  all  requisi- 
tions for  medicines,  surgical  instruments  and  supplies 
are  referred  to  that  department  and  are  filled  by  it. 

It  was  that  department  which  made  the  purchase  of 
the  X-ray  outfit,  in  reference  to  which  Dr.  Reed  makes 
statements  that  are  quite  erroneous.  He  states  that  a 
request  was  made  in  Washington  by  the  Health  Depart- 
ment's expert  to  be  allowed  to  select  the  Crookes'  tubes 
of  an  X-ray  outfit,  and  that  this  request  was  peremp- 
torily refused.  This  statement  evidences  either  woeful 
ignorance  or  a  willful  misstatement  of  fact,  and  the 
Doctor  tries  to  make  matters  appear  still  worse  by  stat- 
ing that  although  no  X-ray  outfit  had  reached  the  Isth- 
mus, the  salary  of  the  expert  who  had  been  specially 
employed  to  do  X-ray  work  in  Ancon  goes  on.  This 
expert  is  Dr.  Herrick,  who  is  the  pathologist  at  Ancon 
Hospital,  and  who  will  have  charge  of  such  instruments 
and  appliances  as  are  required  in  the  laboratory,  includ- 
ing the  X-ray  outfit.  Full  service  is  being  rendered  by 
Dr.  Herrick  in  his  capacity  as  pathologist  for  the  salary 
which  still  goes  on. 

No  request  to  assist  in  the  selection  of  the  X-ray  outfit 
or  of  the  Crookes'  tubes  was  denied;  on  the  contrary, 
Dr.  Herrick  was  told  that  any  service  he  desired  to  ren- 
der in  the  selection  of  such  apparatus  or  of  microscopes 
would  be  welcomed  by  the  Commission.  Dr.  Herrick, 
in  November,  1904,  came  to  the  Washington  of^ce  with 


12 


a  letter  from  Dr.  LaGarde,  Superintendent  of  Ancon 
Hospital,  from  which  the  following  is  an  extract: 

"Mr.  Herrick  leaves  here  to-morrow  for  a  much- 
needed  rest.  He  has  aided  me  more  than  anyone  in  the 
organizing  of  our  important  hospital.  I  desire  very- 
much  that  he  should  be  consulted  by  the  Purchasing 
Agent  in  New  York  in  the  purchase  of  microscopic, 
X-ray,  and  operating-room  supplies,  that  are  costly  and 
that  must  be  of  certain  standards  and  quality  to  suit  our 
needs.  No  one  but  an  expert  like  Herrick  can  intelli- 
gently do  such  purchasing,  and  I  write  to  ask  if  you  will 
be  kind  enough  to  give  him  a  letter  to  Mr.  Anderson, 
explaining  the  necessity  of  such  advice,  or,  in  fact,  let 
Herrick  do  the  selecting  himself." 

This  letter,  addressed  to  the  Chairman  of  the  Com- 
mission, was  presented  in  person  to  the  Acting  Chair- 
man, and  Dr.  Herrick  was  told  that  the  Commission 
would  be  glad  to  accede  to  the  request  of  Dr.  LaGarde 
and  requested  his  assistance  in  the  matter.  Dr.  Herrick 
was  informed  that  the  matter  of  soliciting  proposals  was 
no  longer  in  the  hands  of  Mr.  Anderson.  He  was  refer- 
red to  Mr.  Redfern,  the  Chief  Clerk  of  the  Commission, 
in  direct  charge,  at  that  time,  of  the  filling  of  requisi- 
tions. In  this  connection  Mr.  Redfern,  upon  being 
requested  to  state  what  happened  thereafter  says,  in 
reference  to  the  purchase  of  microscopes,  apochromatic 
objectives,  and  an  X-ray  outfit,  that  these  comprised  one 
dissecting  microscope,  Leitz  No.  44;  three  ordinary 
microscopes  for  hospital  use,  and  one  Zeiss  microscope, 
complete,  besides  the  objectives,  compensating  eye 
pieces  and  a  Spencer  Lens  Co.'s  new  No.  4  stand.  He 
states  that  the  requisition  for  these  instruments  were 
being  handled  at  the  time  of  Dr.  Herrick's  visit  to  Wash- 
ington; that  Dr.  Herrick  was  referred  to  him  (Redfern) 
by  the  Acting  Chairman,  and  that  he  (Redfern)  was  in- 


13 

structed  to  consult  Dr.  Herrick  and  obtain  his  views  as 
to  what  he  desired  to  do  in  the  matter  before  making 
any  purchases  or  definite  arrangements  in  regard  to  the 
Zeiss  microscope  and  X-ray  outfit.  Mr.  Redfern  further 
says  that  he  was  present  at  a  part  of  the  interview  be- 
tween the  Acting  Chairman  and  Dr.  Herrick,  and  that 
Dr.  Herrick  expressed  a  desire  to  superintend  to  a  more 
or  less  degree  the  purchase  of  the  instruments  referred 
to;  that  Dr.  Herrick  called  on  him  (Redfern)  on  the 
following  day  (as  he  remembers)  and  was  requested 
to  give  the  matter  of  the  purchase  of  the  microscope  and 
of  the  X-ray  outfit  his  attention;  that  for  personal  rea- 
sons it  was  not  convenient  for  Dr.  Herrick  to  give  these 
purchases  the  required  attention;  moreover,  that  even 
in  the  case  of  the  X-ray  outfit  there  were  several  makes 
equally  as  good  as  the  one  specified,  any  one  of  which 
would  suit  him.  Mr.  Redfern  further  states  that  the 
dissecting  microscope,  Leitz  No.  44,  was  bought  from 
Ernest  Leitz,  of  New  York,  after  having  referred  the 
matter  to  the  Public  Health  and  Marine  Hospital  for 
advice.  The  three  ordinary  microscopes  were  purchased 
for  the  Commission  by  the  Public  Health  and  Marine 
Hospital  Service,  the  style  purchased  being  the  "Con- 
tinental," and  the  firm  from  whom  they  were  purchased 
was  Bausch  and  Lomb,  of  New  York.  The  apochro- 
matic  objectives,  the  Zeiss  microscope  and  the  X-ray 
outfit  were  bought  by  the  Public  Health  and  Marine 
Hospital  Service.  It  was  understood  that  these  instru- 
ments would  be  tested  for  the  Public  Health  and  Marine 
Hospital  Service  by  the  Director  of  the  Hygienic  Labo- 
ratory of  that  Service  at  Washington. 

It  is  stated  by  Dr.  Reed  that  the  Commission  substi- 
tuted a  number  of  worthless  microscope  objectives  for 
others  carefully  specified.  The  purchase  of  these  has 
above  been  explained.     The  Commission  has  at  no  time 


14 

authorized  the  substitution  nor  the  acceptance  of  any 
"worthless"  instruments. 

Dr.  Reed  says  that  one  medicine  is  substituted  for  an- 
other in  practically  every  requisition  for  medicine  that 
has  reached  the  hospital.  The  Commission  knows  of 
no  such  substitution.  It  has  been  aided,  as  explained, 
by  Col.  Turrell,  the  Medical  Purveyor  for  the  U.  S.  A., 
and  by  the  Public  Health  and  U.  S.  Marine  Hospital 
Service,  and  it  has  no  grounds  for  assuming  that  either 
of  these  departments  should  have  sanctioned  the  pur- 
chase of  medicines  other  than  those  asked  for,  nor  have 
its  medical  officers  ever  reported  such  a  substitution. 

The  statements  of  Dr.  Reed  that  a  request  to  have  an 
expert  select  Crookes'  tubes,  was  denied;  that  no  X-ray 
outfit  was  purchased;  that  worthless  apparatus  was  sub- 
stituted by  the  Commission  for  that  specified;  that  the 
Commission  foisted  remedies  upon  the  medical  service, 
other  than  those  specified,  are  all  absolutely  false. 

Relating  to  Dr.  Reed's  statement  that  the  Commis- 
sion wants  cheap  doctors  on  the  Isthmus,  only  $50  per 
month  being  allowed  for  the  internes,  the  fact  is  that 
graduates  from  medical  colleges,  without  experience, 
are  useful  as  internes  in  the  hospital  organization  on  the 
Isthmus  as  they  are  in  hospital  organization  in  the 
United  States.  In  the  United  States  they  serve  a  year 
without  pay.  It  was  thought  proper  to  allow  them 
transportation  to  the  Isthmus  from  the  United  States 
port,  and  to  allow  them  $50  per  monh  during  their  year 
of  service,  and  to  return  them  free  of  expense  to  the 
United  States  at  the  end  of  the  year  or  in  case  of  dis- 
ability due  to  sickness.  Should  it  be  found  that  an  in- 
terne desires  to  remain  in  the  Isthmian  service,  the  as- 
signment to  further  duty  carries  with  it  pay  of 
at  least  $125  per  month.  To  the  above  compensation  for 
internes  there  is  added  quarters,  board  and  some  laun- 


15 

dry.  Nor  is  there  any  reason  why  a  doctor  promoted 
from  an  interneship  should  not,  if  he  is  deserving,  be 
recommended  at  once  for  higher  pay  than  $125  per 
month,  which  has  been  named  as  a  minimum.  It  is  true 
that  internes  are  expected  to  remain  a  year  to  entitle 
them  to  free  return  transportation,  but  after  six  months 
of  satisfactory  service  they  are  entitled  to  any  reduced 
rates  of  transportation  available  to  the  Commission 
($25  to  New  York  or  New  Orleans).  That  the  Com- 
mission does  not  seek  cheap  medical  service  is  further 
answered  by  quoting  the  salaries  fixed  six  months  ago 
for  such  service:  Chief  Sanitary  Officer,  $7,500  per  year; 
Executive  Officer  in  the  Office  of  the  Sanitary  Officer  (a 
physician),  $2,400;  Director  of  Hospitals,  $7,000;  Super- 
intendent of  Ancon  Hospital,  $6,000;  Pathologist  and 
X-ray  Specialist  at  Ancon,  $4,000;  Physiological  Chem- 
ist at  Ancon,  $3,000;  two  other  physicians  at  $2,400  and 
two  at  $1,500;  and  internes  at  $600;  Superintendent  of 
Colon  Hospital,  $4,000;  Surgeon  and  Pathologist  at 
Colon,  $3,000;  three  other  physicians,  $2,400;  internes, 
$600;  Physicians  at  Emergency  Hospitals  along  the  line 
of  the  Canal,  $2,400;  at  Dispensaries,  $1,800;  Chief 
Quarantine  Officer,  $6,000;  other  Quarantine  Officers, 
two  at  $3,500,  two  at  $2,400;  Panama  Health  Officer, 
$3,000;  Assistant  Health  Officer,  $1,800;  Colon  Health 
Officer,  $2,400.  In  addition  to  this,  all  physicians  are 
allowed  quarters,  or,  in  commutation  of  quarters,  15  per 
cent,  of  their  pay,  and  the  Commission's  principal  repre- 
sentatives on  the  Isthmus  are  allowed  carriages. 

In  the  matter  of  Director  of  Hospitals,  which  you  are 
told  was  abolished,  there  has  been  no  abolishment  of  the 
office,  although  the  Commission  did  request  from  its 
Chief  Sanitary  Officer,  after  the  resignation  of  Dr.  John 
Ross,  because  of  ill  health,  a  suggestion  for  the  reor- 
ganization  of   his   office,   which   reorganization   should 


i6 


provide  for  an  Assistant  Chief  Sanitary  Officer  in  lieu 
of  the  Director  of  Hospitals.  In  view  of  the  fact  that 
the  laws  of  the  Canal  Zone  creating  the  office  of  Di- 
rector of  Hospitals  can  no  longer  be  amended  by  the 
Commission,  it  is  not  likely  that  further  steps  in  this 
matter  will  be  taken. 

The  non-allowance  of  twenty  sanitary  inspectors  to 
serve  in  the  Canal  Zone  under  the  Chief  Inspector  was 
one  of  the  modifications  of  the  suggestions  of  the  Chief 
Sanitary  Officer,  already  alluded  to.  On  this  subject 
the  report  on  the  plan  of  organization  may  be  quoted : 

"No  work  to  be  done  by  the  Sanitary  Force  upon  the 
Isthmus  is  of  greater  importance  than  that  which,  by 
restricting  the  breeding  of  anopheles  and  stegomezia 
mosquitos,  will  reduce  the  danger  of  malarial  and  yel- 
low fever  infection.  This  work  is  now  in  charge  of  a 
Chief  Sanitary  Inspector,  under  whom  there  are  four 
assistant  inspectors,  more  being  at  once  required.  .  .  . 
An  efficient  beginning  can  be  made  with  eight  inspectors 
in  the  Canal  Zone,  and  these  should  be  provided." 

These  were  provided,  together  with  i6  sanitary  fore- 
men, their  number  to  be  increased  from  time  to  time  as 
shown  to  be  necessary  by  experience.  To  this  time  no 
request  for  an  increase  has  been  made  by  the  officers 
whose  experience  would  guide  the  Commission  in  such 
matters.  • 

It  is  stated  by  Dr.  Reed  that  screens  were  asked  for 
for  all  the  buildings  in  the  Canal  Zone;  that  the  Com- 
mission concluded  this  to  be  a  totally  unwarranted  ex- 
pense, and  eliminated  the  proposition.  The  Commis- 
sion has  reached  no  such  conclusion;  moreover,  feels 
itself  under  obligation  not  only  to  provide  screens  for 
all  buildings  owned  or  controlled  by  it,  but  would  like 
to  see  all  buildings  where  screens  would  be  of  any  serv- 
ice suitably  screened. 


17 

The  original  proposition  of  the  Chief  Sanitary  Officer 
to  construct  screens  entirely  around  the  verandas  or 
porches  surrounding  the  Ancon  Hospital  buildings  was 
modified,  as  stated  by  Dr.  Reed,  but  with  the  consent 
and  full  approval  of  the  Medical  Staff,  so  far  as  screen- 
ing only  that  part  of  the  galleries  which  will  be  in  use 
by  the  patients  is  concerned.  The  boarding  below  the 
railing,  or  some  other  means  of  protecting  the  screen- 
ing against  accident,  remains  as  a  suggestion,  and  the 
Commission  has  no  information  of  its  final  acceptance 
or  rejection  by  its  representatives  on  the  Isthmus. 

The  statement  made  by  Dr.  Reed,  that  such  a  propo- 
sition would  carry  about  ten  times  the  expense  of 
screening,  is  in  error.  The  reduction  of  aggregate  cost 
resulting  from  the  plan  of  screening,  as  adopted,  would 
amount  to  many  thousands  of  dollars,  and  would  place 
a  large  amount  of  screening  under  the  protection  of 
porches  where  increased  length  of  serviceability  is  to  be 
assumed.  The  cost  of  boards  in  the  place  of  screens, 
instead  of  being  ten  times  greater,  should  be  compared 
on  the  basis  of  about  six  (6)  cents  per  square  foot  for 
screens,  as  against  three  (3)  cents  for  boards,  apart  in 
each  case  from  the  cost  of  placing  these  materials. 

In  the  matter  of  compensation  allowed  its  clerks, 
which  Dr.  Reed  criticizes,  the  Commission  has  endeav- 
ored to  secure  a  fair  and  uniform  classification  in  its 
several  departments,  and  the  salaries  fixed  were  the  out- 
come of  long  discussion  and  deliberation,  the  intention 
being  to  fix  salaries  for  all  such  service  at  about  25  per 
cent,  in  excess  of  the  amount  which  like  service  would 
command  in  the  United  States. 

The  Doctor  states  in  this  connection  that  "Colonel 
Gorgas  asked  for  a  Chief  Clerk  at  $1,800,  with  the  ob- 
ject of  getting  a  man  who  had  had  experience  with  him 
in  Cuba;  he  was  allowed  only  $1,500,  for  which  he  could 


i8 


get  only  an  inexperienced  man.''  The  salary  fixed  in 
the  plan  of  organization  for  the  Chief  Clerks  of  the 
Chief  Sanitary  Officer  (see  page  171  of  the  printed  pro- 
ceedings of  the  Commission)  is  $1,800;  the  salary  of  the 
Clerk  in  the  office  of  Director  of  Hospitals,  called  by 
courtesy  Chief  Clerk,  is  $1,500;  the  salary  of  the  Chief 
Clerk  of  Ancon  Hospital  is  $1,800  per  year. 

It  should  be  stated  that  the  fixing  of  salaries  of  the 
officers  of  the  Health  Department  has  received  careful 
consideration  by  the  Commission.  Salaries,  in  connec- 
tion with  all  other  matters  relating  to  the  organization 
of  the  Health  Department,  were  discussed  and  agreed 
upon  in  conference  with  the  Medical  Staff,  and  they  re- 
main subject  to  revision.  There  are,  in  fact,  frequent 
changes,  and  it  is  needless  to  say  that  a  change  invaria- 
bly means  increase.  Some  of  these  salaries  have  herein- 
before been  enumerated. 

In  the  matter  of  the  use  of  movable  vessels  for  night 
soil,  it  may  be  stated  that  those  called  for  have  been  pur- 
chased. On  this  subject,  after  discussing  the  advan- 
tages and  disadvantages  of  disposal  by  water  carriage 
in  sewers,  as  against  the  use  of  a  bucket  system,  Dr. 
Gorgas,  under  date  of  January  7th,  concluded :  *T  would, 
therefore,  recommend  that  in  general,  for  the  strip,  the 
bucket  system  be  adopted,  and  that  the  Sanitary  Depart- 
ment be  authorized  to  install  the  same  as  necessity 
arises."  Hereupon  Governor  Davis  took  up  the  ques- 
tion, writing  under  date  of  January  17th,  among  other 
things :  **It  seems  to  me  that  it  should  not  be  a  very  diffi- 
cult matter  to  arrange  that  each  house,  or  group  of  two 
or  three  houses,  should  be  provided  with  a  small  privy, 
constructed  of  boards,  over  a  pit  dug  in  the  earth,  and 
provided  with  steps  and  seats,  and  that  the  Sanitarians 
should  inspect  these  privies  occasionally,  and  see  that 
they  are  kept  in  proper  condition,  and  removed  from 


19 

time  to  time  to  other  pits  when  it  shall  appear  neces- 
sary." 

The  Commission  thereupon,  at  its  meeting  on  the  4th 
of  February,  1905,  adopted  a  report  of  its  Committee  on 
Sanitation,  which  was  sent  to  the  Isthmus  for  further 
comment  by  the  Governor  of  the  Canal  Zone  and  the 
Chief  Sanitary  Officer. 

Referring  to  this  resolution,  Governor  Davis,  under 
date  of  February  25th,  writes :  "It  will  be  observed  that 
Col.  Gorgas  sees  no  necessity  for  any  action  by  the 
Commission  in  this  matter,  and  I  have  not,  myself,  been 
able  to  think  of  any  phase  of  the  case  that  requires  such 
action." 

"Since  my  letter  of  January  17th,  the  subject  of  the 
use  along  the  Canal  line  of  privies  and  privy  vaults  for 
night  soil,  and  before  the  receipt  of  the  Secretary's  com- 
munication now  at  hand,  was  taken  up  by  me  with  Col. 
Gorgas  and  Mr.  Le  Prince,  and  I  personally  made  a 
sketch  of  a  privy  vault,  or  pit,  that  I  thought  would 
meet  the  case,  and  the  instructions  I  gave  to  prevent 
the  vault  or  pit  from  being  flooded  were  almost  exactly 
the  same  as  those  suggested  in  the  memorandum  of  the 
Committee  on  Sanitation.  .  .  .  The  Commission 
will  be  kept  advised  as  to  the  experience  in  this  matter, 
and  if  any  necessity  arises  for  action  by  resolution  or  in 
a  legislative  way,  the  fact  will  be  made  known." 

On  the  same  subject,  under  date  of  February  24th, 
Chief  Sanitary  Officer  Col.  W.  C  Gorgas  writes :  .  .  . 
"In  my  opinion  no  special  regulation  by  the  Commis- 
sion is  necessary  for  carrying  out  the  views  expressed 
in  this  resolution.  .  .  .  The  scheme  seems  to  me 
good  and  to  fulfill  the  requirements.  If  upon  trial  it  is 
not  found  satisfactory,  I  shall  report  the  circumstances 
to  the  proper  authorities." 


20 

Dr.  Reed  tells  you  that  the  establishment  of  a  con- 
valescent hospital  on  the  Island  of  Taboga,  with  a  doc- 
tor and  a  head  nurse,  was  refused.  Taboga  is  located 
about  twelve  miles  down  the  Bay  of  Panama,  and  the 
use  of  the  island  as  a  hospital  will  involve  the  keeping 
of  a  suitable  steamer  in  service.  It  should  be  stated 
that  the  Commission  resolved  in  August,  1904,  as  fol- 
lows :  "The  large  two-story  structure  on  Taboga  Island, 
usually  referred  to  as  the  'Convalescent  Hospital,'  is 
suitable  for  a  convalescent  station  to  be  made  use  of 
whenever  the  hospital  facilities  at  Ancon  prove  inade- 
quate. There  is  no  immediate  need  of  providing  a 
medical  staff  for  this  station.  It  is  estimated  that  $8,500 
will  be  required  to  put  the  building  in  a  suitable  condi- 
tion of  repair."  This  expenditure  was  authorized  by 
resolution  on  September  2,  1904,  and  the  Commission 
has,  since  that  time,  upon  recommendation  of  the  Chief 
Sanitary  Officer,  authorized  the  furnishing  and  use  of 
this  station  by  canal  employes  who  need  a  change  of 
air  and  of  surroundings  to  recuperate  their  energies. 

Another  of  the  Doctor's  misstatements  relates  to 
Miraflores  Hospital.  The  establishment  of  this  hos- 
pital was  authorized  immediately  it  was  asked  for.  The 
transfer  of  personnel  was  authorized,  and  no  obstruction 
has  been  interposed  by  the  Commission  to  the  filling  of 
any  vacancies  created  by  such  transfer. 

You  are  told  by  Dr.  Reed  that  the  Commission  de- 
clined to  give  the  Chief  Sanitary  Officer  some  oppor- 
tunity to  exercise  his  judgment  as  to  qualification  of 
personnel  and  quality  of  material  furnished  his  depart- 
ment. The  present  medical  staff  is  of  his  own  selection. 
He  has  been  restricted  only  by  civil  service  regulations. 
The  method  followed  in  purchasing  medicines  and  sup- 
plies has  already  been  explained. 


21 


You  are  told  that  the  Health  Department  is  hampered 
in  its  efforts  to  suppress  yellow  fever.  In  this  connec- 
tion it  is  only  necessary  to  call  attention  to  the  fact  that 
materials  for  use  in  disinfecting  have  been  purchased  as 
required,  the  following  aggregate  amounts  of  materials, 
principally  used,  purchased  and  forwarded : 


14  tons  of  insect  powder  in  16  shipments. 
52  tons  of  sulphur  in  17  shipments. 
2  tons  of  sulphate  of  iron. 
23  tons  of  chloride  of  lime. 
500  lbs.  of  sulphate  of  copper. 


Regular  shipments  of  insect  powder  and  roll  sulphur 
are  being  made,  and  will  be  continued  until  notice  is 
received  from  the  Sanitary  Department  that  they  are  no 
longer  needed. 

The  Commission  has  at  all  times  met  every  request 
for  such  material  promptly.  If  some  allowance  be  now 
made  for  misunderstandings  as  to  what  was  required, 
and  on  the  other  hand  for  some  duplication  of  pur- 
chases resulting  from  the  use  of  the  cable,  it  must  be 
apparent  that  any  difference  in  the  amount  of  a  single 
shipment  from  the  amount  named  in  a  requisition  should 
not  be  used  as  a  reflection  upon  the  earnest  effort  of  the 
Commission  to  do  effective  sanitary  work. 

The  following  two  letters  from  the  Chairman  of  the 
Commission,  one  under  date  of  January  5,  1905,  to  Gen- 
eral Davis,  the  other  under  date  of  February  14,  1905, 
to  Mr.  E.  C.  Tobey,  Chief  of  Material  and  Supplies  De- 
partment, will  sufficiently  illustrate  the  attention  given 
to  such  matters. 

The  addresses  and  signatures  being  omitted,  these 
letters  are  as  follows : 


22 


*'Sir: 

^'I  this  morning  received  your  cable  of  yesterday  as 
follows : 

"Health  Department  will  systematically  fumigate 
Panama;  require  2,000  pounds  insect  powder  weekly 
for  six  weeks;  present  supply  exhausted  January  15th; 
can  I  depend  upon  required  shipments." 

To  which  I  have  replied : 

"Will  send  2,000  pounds  insect  powder  weekh^ 
"In  this  connection  I  have  to  inform  you  that  the 
steamer  sailing  yesterday  took  two  orders  of  disinfecting 
material — one  for  eight  (8)  tons  of  rolled  sulphur  and 
one  (i)  ton  of  insect  powder,  and  the  other  for  5,000 
pounds  of  rolled  sulphur  and  4,000  pounds  of  insect 
powder. 

"The  2,000  pounds  of  insect  powder  which  you  request 
weekly  for  six  successive  weeks,  will  be  forwarded  you, 
beginning  Tuesday,  the  loth  inst." 

And  the  letter  to  Mr.  Tobey: 

"Dear  Sir: 

"Referring  to  cable  sent  by  General  Davis,  received  at 
this  office  on  the  5th  day  of  January,  1905,  requesting 
that  six  weekly  shipments  be  made  of  insect  powder  in 
2,000  pound  lots : 

"I  wish  to  bring  to  your  attention  that  under  this 
order  the  shipments  would  cease  on  the  14th  day  of 
February.  To  guard  against  possible  chance  that  the 
supply  should  become  exhausted,  I  have  this  day 
directed  that  two  more  consignments  of  2,000  pounds 
each  be  made,  bringing  the  total  quantity  up  to  16,000 
pounds  and  to  the  28th  day  of  this  month.  Upon  receipt 
of  this  letter  should  the  conditions  warrant  the  con- 
tinuing of  these  weekly  shipments,  you  are  directed  to 
cable  such  request." 

In  further  evidence  of  the  earnest  desire  to  facilitate 


23 

the  work  of  the  Health  Department  in  preventing  and 
suppressing  epidemics  the  Commission  enacted  the  fol- 
lowing in  Act  No.  8,  of  the  Laws  of  the  Canal  Zone : 

"But  in  case  of  emergency  created  by  threatened  or 
imminent  danger  to  the  public  health,  extraordinary 
expenditures  by  the  Board  of  Health  may  be  authorized 
by  the  Governor  of  the  Canal  Zone." 

Under  this  authorization  medical  and  sanitary  sup- 
plies have  been  and  can  be  purchased  as  required. 

The  Commission  on  September  2,  1904,  also  passed 
the  following  resolution: 

''Resolved,  That  in  case  of  any  great  public  calamity, 
emergency,  or  urgent  necessity,  the  member  or  mem- 
bers of  the  Commission  on  the  Isthmus  of  Panama  be, 
and  they  hereby  are  authorized  to  act  for  the  Commis- 
sion, taking  such  measures  as  may  be  necessary  to  meet 
the  conditions  as  they  arise,  and  to  purchase  materials 
and  to  do  any  work  or  make  any  expenditures,  which 
they  deem  necessary  to  avert  such  calamity  or  to  meet 
such  emergency  and  urgent  necessity." 

You  are  told  by  Dr.  Reed  that  the  Commission  de- 
clared that  screens  for  hospitals  along  the  line  of  the 
canal  were  unnecessary.  This  is  also  a  misstatement, 
the  exact  reverse  being  the  case. 

Building  repairs  are  made  under  the  direction  and 
supervision  of  the  Chief  Engineer.  The  Commission 
has  not  been  advised  that  this  arrangement  is  the  cause 
of  any  embarrassment.  The  Commission  has  not,  as 
Dr.  Reed  desires  that  you  should  believe,  required  that 
estimates  should  first  be  submitted  to  the  Commission 
before  repairs  to  buildings  are  made.  The  making  of 
these  repairs  rests  with  the  Commission's  representa- 
tives on  the  Isthmus. 


24 

The  Commission  has  not  denied  a  request  for  a  house 
at  a  quarantine  station.  Full  authorization  for  all  build- 
ings asked  for,  for  the  quarantine  service,  has  been 
given. 

The  Commission  maintains  a  laboratory  at  Ancon 
Hospital.  Even  if  the  Commission  v^ere  clear  that  the 
establishment  of  a  laboratory  for  purely  scientific  re- 
search would  be  a  proper  feature  of  expenditure,  it  does 
not  believe  the  time  to  have  come  for  establishing  one, 
and  denied  a  request  for  such  laboratory.  Dr.  Herrick 
is  the  Commission's  pathologist  at  Ancon  Hospital  and 
X-ray  specialist,  and  it  is  expected  that  at  the  Ancon 
Hospital  laboratory,  for  the  present,  such  scientific  work 
as  may  be  necessary  will  be  done. 

The  keeping  of  the  Ancon  Hospital  ambulance  at  the 
Section  stable,  instead  of  at  a  separate  hospital  stable,  is 
referred  to  by  Dr.  Reed  as  making  it  impossible  to  get 
the  ambulance  on  ready  call  at  times  of  an  emergency. 
No  arrangement  for  stabling  the  ambulance  has  been 
made  which  does  not  give  the  hospital  officials  com- 
plete control  over  its  movements.  It  should  be  stated 
in  this  connection  that  the  Section  stable  is  on  a  tract 
of  land  as  fully  under  the  control  of  the  Commission  as 
the  hospital  site  in  contact  therewith  and  less  than  200 
yards  from  the  hospital  gate  and  connected  by  tele- 
phone. 

The  combination  of  scattered  stables  into  one  estab- 
lishment is  a  feature  of  efficient  administration. 

It  is  charged  by  Dr.  Reed  that  the  Commission's 
hospitals  are  opened  to  all  the  world.  No  other  answer 
seems  necessary  than  a  reference  to  the  plan  of  organiza- 
tion and  to  the  health  regulations  as  set  forth  in  the 
Laws  of  the  Canal  Zone.  (See  Acts  Nos.  8  and  9.) 
The  medical  staff  should  have  power  to  order  into  hos- 
pitals all  persons  suspected  of  being  ill  with  infectious 


or  contagious  diseases,  and  this  has  been  given.  The 
Commission  foresaw  that  restrictions  would  be  neces- 
sary to  prevent  competition  by  the  hospitals  with  physi- 
cians in  private  practice.  The  admission  of  patients  as 
pay  or  charity  patients  is  only  permitted  where  the 
hospital  authorities  determine  such  admission  to  be 
desirable.  It  was  not  intended  that  any  sick  person  not 
an  employe  of  the  Commission  should  be  admitted  upon 
mere  application,  and  so  far  as  the  Commission  has  been 
advised  no  other  construction  has  been  placed  upon  the 
paragraphs  of  the  plan  of  organization  relating  to  ad- 
mission of  patients. 

To  establish  a  proper  relation  between  the  Commis- 
sion's hospitals  and  their  medical  staffs,  on  the  one  hand, 
and  the  private  physicians  practicing  on  the  Isthmus,  on 
the  other,  the  Commission  will  always  be  ready  to  take 
suitable  action. 

It  has  recently,  upon  the  receipt  of  a  suggestion, 
relating  to  this  matter,  passed  the  following  resolution 
which  was  suggested  by  the  Chief  Sanitary  Officer : 

^'Resolved,  That  any  pay  patient  can  employ  any  phy- 
sician desired  by  such  patient,  and  such  physician  can 
have  access  to  such  patient  and  use  of  all  supplies  and 
conveniences  of  the  hospital,  under  regulations  to  be 
prescribed.  A  charge  of  not  less  than  $5.00  and  not 
more  than  $10.00  will  be  made  for  the  use  of  operating 
room. 

"In  case  a  pay  patient  in  a  hospital  elects  to  have  a 
physician  employed  by  the  Commission  attend  him  or 
her,  the  Superintendent  shall  charge  for  such  attend- 
ance or  surgical  operation  in  accordance  with  the  scale 
of  fees,  to  be  agreed  upon  between  the  Chief  Sanitary 
Officer,  on  the  one  hand,  and  the  legally  qualified  medi- 
cal men  of  Panama  and  Colon,  on  the  other." 

This  resolution  was  adopted  at  the  request  of  Dr. 


26 


Gorgas.  The  Commission  is  by  no  means  certain  that  it 
will  not  soon  require  further  modification,  which  will 
be  made  when  asked  for,  but  for  the  present  accepts  the 
view  of  Col.  Gorgas,  who,  under  date  of  December  6, 
1904,  referring  thereto,  says :  "I  have  discussed  this 
with  a  committee  appointed  to  represent  the  physicians 
(referring  to  the  medical  profession  of  Panama),  and 
they  express  themselves  as  being  satisfied  with  the 
arrangements.  This  will  give  them  access  to  the  hos- 
pital and  the  advantages  of  the  hospital,  and  they  will 
make  such  arrangements  as  they  please  with  their 
patients,  just  as  if  the  patient  were  in  a  hotel." 

In  reference  to  the  admission  of  all  the  world  to  the 
hospitals,  it  may  be  stated  that  the  views  of  Col.  Gorgas 
were  so  extreme  in  August,  1904,  that  his  original  sug- 
gestion included  the  taking  over  and  management,  as 
already  stated,  of  the  hospitals  and  poorhouse  of  the 
Republic  of  Panama. 

Dr.  Reed  is  again  in  error  when  he  says  that  it  was 
"made  a  part  of  the  Laws  of  the  Canal  Zone  'that  sur- 
gical operations  shall  be  charged  for  according  to  their 
importance  and  the  financial  ability  of  the  patient  to 
pay,  but  no  charge  in  excess  of  $50.00.  shall  be  made 
without  the  approval  of  the  Director  of  Hospitals.'  " 
This  is  a  quotation  from  page  166  of  the  minutes  of  the 
proceedings  of  the  Commission;  it  forms  no  part  of  the 
Laws  of  the  Canal  Zone.  It  has,  as  just  stated,  been 
already  changed,  based  on  the  experience  and  recom- 
mendation of  the  medical  staff. 

The  purpose  of  the  requirement  that  a  charge  be 
made  under  certain  circumstances  for  attendance  upon 
sick  at  their  homes  was  to  encourage  the  persons  enti- 
tled to  hospital  treatment,  and  to  free  rriedical  treat- 
ment, to  seek  medical  advice  at  the  dispensaries  and  at 


27 

the  hospitals,  thereby  reducing  the  number  of  outside 
calls  to  be  made  by  the  Commission's  physicians.  The 
charge  for  such  attendance  is  in  no  sense,  as  Dr.  Reed 
would  have  you  believe,  a  charge  in  competition  v^ith 
private  practitioners,  or  in  compensation  for  the  services 
rendered.  He  has  quoted  only  enough  to  mislead,  from 
the  report  on  the  plan  of  hospital  organization.  The  full 
statement  in  that  report  relating  to  this  matter  as  taken 
from  the  printed  proceedings  of  the  Commission  is  as 
follows : 

^'Visits  made  by  physicians  to  the  residence  of  any 
person  entitled  to  free  hospital  treatment,  or  to  the 
residence  of  a  railroad  employe,  or  to  the  residence  of 
any  other  person  entitled  to  treatment  at  the  hospital  at 
a  fixed  daily  rate  of  pay,  should  be  charged  for  at  the 
rate  of  one-half  dollar  for  each  visit,  but  no  such  charge 
is  to  be  made  for  emergency  calls  nor  in  the  case  of  per- 
sons entitled  to  free  hospital  treatment  until  after  the 
person  has  been  ordered  into  a  hospital." 

It  is  true  that  the  Commission  has  declared  that  all 
money  realized  at  hospitals  from  charges  for  board,  med- 
ical attendance,  surgical  operations  and  the  like,  and 
from  visits  at  residences,  should  be  considered  public 
funds.  This  is  covered  by  the  Laws  of  the  Canal  Zone 
in  the  following  words : 

"All  money  collected  for  the  United  States  by  the 
Department  of  Health,  or  any  of  its  several  branches 
or  services,  or  by  any  officer  or  employe  thereof,  shall  be 
turned  over  to  the  Government  of  the  Canal  Zone  as 
soon  as  practicable  after  the  date  of  its  receipt." 

Two  of  the  members  of  the  present  Commission  have 
repeatedly  visited  the  Isthmus  in  the  last  five  years,  and 


^B'^.A  -pj. 


28 


they  know  that  the  Isthmus  during  this  entire  time  was 
never  free  from  yellow  fever.  Why  does  Dr.  Reed  now 
venture  such  a  statement,  referring  to  the  last  days  of 
June,  1904,  as  the  following:  'Tanama  was  then  ap- 
parently free  from  yellow  fever?" 

Yellow  fever  being  still  endemic  in  the  city  of  Panama, 
the  Commission  has  taken  vigorous  measures  to  stamp 
it  out.  It  is  considered  of  prime  importance  to  exter- 
minate the  stegomeyia  mosquito  in  Panama.  The  Com- 
mission at  once  recognized  the  importance  of  bringing 
into  Panama  a  wholesome  water  supply,  and  no  time 
has  been  lost  in  selecting  a  source  of  supply  and  pur- 
chasing material.  Only  after  water  is  thus  made  avail- 
able can  the  use  of  water  containers,  the  favorite  breed- 
ing place  of  this  particular  mosquito,  be  prohibited. 

In  the  meanwhile  the  Commission  appointed  a  Health 
Officer  for  the  City  of  Panama,  its  Board  of  Health  took 
charge  of  all  suspected  cases  of  yellow  fever  wherever 
found,  and  provision  was  made  to  have  funds  in  any 
amount  at  its  disposal  in  case  of  an  emergency,  as 
already  hereinbefore  stated. 

It  is  true  that  the  Treaty  between  the  United  States 
and  Panama  gives  to  the  United  States  certain  rights  in 
the  matter  of  prescribing  and  enforcing  sanitary  regula- 
tions in  the  Cities  of  Panama  and  Colon.  The  follow- 
ing is  from  Article  VI  of  the  Treaty : 

'The  Republic  of  Panama  agrees  that  the  Cities  of 
Panama  and  Colon  shall  comply  in  perpetuity  with  sani- 
tary ordinances  whether  of  a  preventive  or  curative 
character  prescribed  by  the  United  States,  and  in  case 
the  Government  of  Panama  is  unable  or  fails  in  its 
duty  to  enforce  this  compliance  by  the  Cities  of  Panama 
and  Colon,  with  the  sanitary  ordinances  of  the  United 
States,  the  Republic  of  Panama  grants  to  the  United 
States  the  right  and  authority  to  enforce  the  same." 


29 

The  Commission  gave  its  Health  Department  a  tem- 
porary organization  by  formal  action  at  its  session  on 
May  8,  1904.  At  this  meeting:  "The  Chief  Sanitary 
Officer  and  the  Director  of  Hospitals,  in  addition  to 
other  duties,  were  designated  as  the  Health  Board  for 
Colon  and  Panama,"  and  the  Chief  Sanitary  Officer  took 
such  steps  as  he  thought  justified  to  improve  the  sani- 
tary conditions  in  these  cities.  He  asked  for,  and  was 
given,  certain  powers  in  this  matter  by  the  Government 
of  the  Republic  of  Panama,  and  continued  to  exercise 
these  until  the  scheme  for  a  permanent  organization  of 
the  Health  Department  took  definite  shape.  About  the 
same  time  the  Commission  adopted  sanitary  rules  and 
regulations  for  the  Cities  of  Panama  and  Colon  and 
quarantine  regulations  for  the  ports  and  harbors  of  these 
cities. 

At  the  Commission's  meeting  of  September  2,  1904, 
the  Chairman  was  directed  to  transmit  a  copy  of  these 
rules  and  regulations  to  the  proper  authorities  of  the 
Republic  of  Panama,  with  the  request  that  such  action 
betakenby  competent  authorities  as  might  be  necessary 
to  give  the  rules  and  regulations  the  force  of  law.  This 
was  done,  and  suitable  action  was  subsequently  taken 
by  the  Government  of  Panama. 

Not  until  January,  1905,  was  the  Commission  advised 
by  the  authorities  of  Panama  of  its  inability  to  properly 
enforce  these  regulations,  and  the  Commission  imme- 
diately took  full  charge  of  the  work  of  cleaning  and 
sanitation  in  Panama.  In  this  matter  the  Commission 
acted  up  to  the  entire  limit  of  its  authority,  as  is  shown 
by  the  following  extract  from  a  decision  of  the  Comp- 
troller of  the  United  States  Treasury,  in  which  he  says : 
*Tt  requires  no  extended  argument  to  demonstrate  that 
until  Panama  confessed  its  inability  or  failed  to  execute 


30 

these  regulations,  the  Government  of  the  United  States 
was  not  authorized  so  to  do,  and  not  being  authorized 
to  execute  them  could  not  legally,  under  such  circum- 
stances, pay  for  their  execution.'' 

It  should  be  further  stated  in  this  connection  that  a 
Health  Office  for  Panama,  with  a  physician  in  charge, 
an  assistant,  two  clerks,  and  three  inspectors  are  in- 
cluded in  the  Health  Department  organization,  and 
were  stationed  there  long  before  the  United  States  took 
charge  of  the  enforcement  of  health  ordinances.  A 
similar  staff,  except  the  assistant  health  officer,  was 
provided  in  the  plan  of  organization  for  Colon.  Dr. 
Reed  lays  great  stress  upon  the  subordination  of  the 
Chief  Sanitary  Officer  to  the  seventh  degree,  enumer- 
ating even  the  President,  and  a  single  member  of  the 
Commission  to  accomplish  this  subordination.  In  the 
discharge  of  his  duties  as  a  sanitary  officer  Dr.  Gorgas 
has  been  absolutely  free  and  has  absolute  freedom  of 
action. 

The  providing  of  water  for  Panama  received  the  at- 
tention of  the  Commission  in  April,  1904,  before  the 
canal  properties  had  passed  into  possession  of  the 
United  States,  it  having  been  resolved  on  April  12  that 
parties  be  organized  as  soon  as  practicable  for  the  doing 
of  the  following  field  work :  .  .  .  "Surveys  for 
water  supply  and  sewerage  systems  for  Colon  and 
Panama." 

Under  this  resolution  an  engineer  of  experience  was 
engaged  and  entered  upon  his  duties  as  soon  as  he  could 
arrange  his  private  affairs,  on  June  20,  1904.  His  duties 
included  the  design  of  water  works  for  Panama,  sewers 
for  Panama,  and  water  works  and  sewers  for  Colon. 

The  cleaning  of  the  streets,  including  the  disposal  of 
night-soil,  was  placed  in  the  hands  of  Col.  Gorgas,  with 


31 

full  powers  so  far  as  the  Commission  could  confer  them, 
on  May  8,  1904. 

Compare  also  this  statement  of  Dr.  Reed  with  the 
facts.  He  says,  referring  to  the  water  works  for  Pan- 
ama :  ''Mr.  Wallace  had  drawn  the  plans  and  specifica- 
tions in  July  previous  and  had  taken  care  to  specify  only 
such  pipe  as  manufacturers  keep  in  stock,  and  that  could,, 
therefore,  be  procured  without  a  moment's  delay."" 
The  facts  are  that  the  recommendation  of  the  Chief 
Engineer  that  the  selection  of  the  Rio  Grande  as  a  source 
of  water  for  Panama  be  approved,  bearing  date  August 
6th  (not  July),  and  that  the  specifications  for  pipe  sub- 
mitted by  him  bear  date  of  August  15th,  and  were  ap- 
proved by  the  Commission  on  August  19th  as  sub- 
mitted. 

The  specifications  as  prepared  had  no  reference  to 
stock  on  hand  by  manufacturers.  All  delay  in  the  deliv- 
ery of  this  cast  iron  pipe  has  been  due  to  a  default  of  the 
contractor  in  making  shipment.  The  pipe  was  manu- 
factured in  time  for  shipment  as  required  by  contract, 
but  the  second  (final)  installment  did  not  get  off  within 
the  contract  time. 

The  Doctor's  ignorance  as  to  the  forms  of  water 
pipe  and  their  method  of  manufacture  has  led  him  into 
a  silly  statement  as  to  their  details.  The  Commission 
never  asked  the  Chief  Engineer  for  any  explanation  as 
to  eastern  or  western  patterns,  as  they  exist  only  in  the 
Doctor's  imagination. 

Every  reasonable  step  is  being  and  will  be  taken  to 
reduce  malaria.  To  this  end  an  efificient  sanitary  corps 
for  the  Canal  Zone  has  been  organized  and  a  vast 
amount  of  good  work  has  been  accomplished.  Any  one 
who  knew  the  Isthmus  before  May  4,  1904,  and  who 
visits   it   now,   can   testify   to   the   changed   conditions. 


32 

Ponds  were  drained  and  oiled,  ditches  constructed  and 
cleaned  out,  and  brush  has  been  cut  out,  improving  the 
surroundings  of  the  several  clusters  of  buildings  in  the 
Canal  Zone. 

The  statement  that  the  Commission  thought  some- 
thing like  20  laborers  too  many  for  the  Health  De- 
partment, and  allowed  only  one-half  of  that  number,  is 
absolutely  false.  Laborers  have  been  allowed  as  re- 
quired and  as  necessary,  and  have  been  numbered  by 
hundreds  in  the  Health  Department. 

Dr.  Reed  says  that  a  call  for  2,500  yards  of  wire 
screening  was  cut  by  the  Commission  to  500  yards.  The 
Commission  has  made  four  purchases  of  wire  screen,  ag- 
gregating upwards  of  17,000  square  yards,  besides  enter- 
ing into  a  $4,700  contract  for  screens  suitably  framed 
for  door  and  window  openings.  None  of  the  calls  for 
screens  was  for  the  amount  of  2,500  yards  as  claimed  by 
Dr.  Reed. 

No  requisition  for  quinine  was  ever  reduced  or  denied. 

Dr.  Reed  is  also  in  error  when  he  states  that  the 
Isthmian  Canal  Commission,  in  its  report  of  December, 
1904,  states: 

*'A11  cases  of  employes  sick  with  malaria  are  taken 
to  Colon  and  Ancon  Hospitals  and  so  screened  that 
mosquitoes  cannot  reach  them." 

Dr.  Reed  calls  this  "an  absolute  and  unqualified  false- 
hood." 

The  words  quoted  by  Dr.  Reed  are  not  those  of  the 
Commission;  they  are  not  in  the  Commission's  report, 
but  appear  in  a  report  of  the  Governor  of  the  Canal 
Zone,  and  probably  have  reference  to  the  use  of  mos- 
quito bars  in  the  hospitals.  Moreover,  if  mosquitoes  are 
not  kept  away  from  malarial  patients  at  Colon  and  An- 


33 

con  Hospitals  by  the  use  of  mosquito  netting,  the 
responsibility  falls  upon  the  medical  officers  of  these 
hospitals. 

You  are  asked  by  Dr.  Reed  to  consider  the  authoriza- 
tion by  the  Commission,  with  the  approval  of  its  medical 
staff,  to  accept  student  nurses  at  Ancon  Hospital  as  a 
mere  subterfuge  to  secure  cheap  nursing. 

The  idea  that  a  training  school  for  nurses  might  prove 
a  success  was  suggested  by  the  application  of  a  young 
woman  of  Panama,  a  member  of  one  of  the  foremost 
families  of  that  Republic,  who  offered  to  render  such 
service  as  she  might,  without  pay,  being  desirous  of  hav- 
ing an  opportunity  to  gain  experience  as  a  nurse,  and 
by  the  statement  made  by  herself  and  friends  that  other 
young  women  of  Panama  would  probably  avail  them- 
selves of  any  suitable  opportunity  to  enter  the  hospital 
as  student  nurses.  On  this  subject  the  report  on  a  plan  of 
organization  says :  "Attention  should  also  be  called  to 
the  fact  that  young  women,  some  from  Panama,  others 
from  the  United  States,  will  be  desirous  of  entering  a 
hospital  so  well  equipped  as  Ancon,  as  student  nurses. 
This  should  be  encouraged.  Climate  and  environment 
are  not  unpleasant,  and  a  good  training  school  for 
nurses  should  prove  attractive,  and  would  add  materially 
to  the  hospital  service.*'  The  scheme  as  authorized 
would  allow  students  compensation  at  the  rate  of  $12 
per  month  during  the  first  year,  $15  during  the  second, 
and  $18  during  the  third.  The  students  would  receive 
traveling  expenses  to  the  Ithmus  from  New  York,  New 
Orleans  or  San  Francisco,  and  free  return  expenses  to 
one  of  these  cities  in  case  of  service  for  at  least  one  year 
or  in  case  of  disability  by  reason  of  illness. 

The  making  of  purchases  of  supplies  and  materials  for 
use  on  the  Isthmus  has  not  been  a  simple  problem.     It 


34 

has  been  and  is  the  desire  of  the  Commission,  so  far  as 
practicable,  to  make  purchases  on  the  basis  of  proposals 
submitted  on  advertisement.  The  following  resolution 
relating  to  this  matter  was  passed  on  August  i8,  1904: 

''Resolved,  That  hereafter,  so  far  as  practicable,  all 
purchases  of  machinery,  material  and  supplies  shall  be 
made  after  due  advertisement  and  competition." 

It  was  on  the  other  hand  necessary,  at  the  outset,  to 
send  to  the  Isthmus  such  amounts  of  material  and  sup- 
plies as  were  required  for  the  work  of  the  Commission, 
and  to  prevent  loss  of  time  and  money  to  the  Govern- 
ment. Open  market  purchases  were,  therefore,  neces- 
sary, but  the  making  of  open  market  purchases  was  stop- 
ped and  restricted  as  soon  as  it  seemed  wise  to  do  this. 

In  making  purchases  by  advertising  for  proposals 
careful  specifications  had  to  take  the  place  of  the  judg- 
ment of  the  Purchasing  Agent  and  of  experts,  and  the 
descriptions  contained  in  requisitions  had  to  be  amplified 
before  a  call  for  proposals  could  be  made.  In  other 
words,  the  requisitions  were  only  a  general  evidence  of 
the  requirement;  specifications  had  in  many  cases  to  be 
subsequently  prepared.  It  has  been  the  plan  of  the 
Commission  to  have  the  needs  of  its  several  departments 
foreseen  for  half  year  or  full  year  periods  in  order  that 
purchases  would  be  in  sufficient  quantities  to  avoid  as 
far  as  possible  emergency  calls  and  to  afford  the  pur- 
chasing officer  ample  time  to  prepare  papers  to  call  for 
proposals  with  a  reasonable  time  allowance  to  permit 
intending  bidders  in  all  parts  of  the  country  to  prepare 
their  proposals,  and  to  permit  of  the  delivery,  or  manu- 
facture and  delivery,  as  the  case  might  be,  of  the  articles 
required. 

We  quote  in  connection  with  the  delivery  of  material 


35 

to  the  Isthmus  from  the  report  of  the  Subcommittee 
of  the  Committee  on  Interstate  and  Foreign  Commerce 
of  the  House  of  Representatives:  "In  fact,  supplies 
were  received  in  such  quantities  and  so  much  more  rap- 
idly than  needed  that  the  terminal  facilities  of  the  rail- 
road were  inadequate  to  care  for  them."  .  .  .  This, 
when  read  in  connection  with  Dr.  Reed's  letter,  may 
illustrate  the  difference  which  the  standpoint  makes 
from  which  the  Commission's  affairs  are  discussed. 

The  Commission,  on  its  first  visit  to  the  Isthmus,  in 
April,  1904,  was  accompanied  by  the  three  chief  mem- 
bers of  the  Sanitary  Corps  of  the  Canal.  They  returned 
together  and  were  in  conference  in  Washington  concern- 
ing the  preliminary  organization  of  the  Health  Depart- 
ment for  the  Zone.  The  views  and  propositions  pre- 
sented by  the  chief  and  associate  sanitary  officers  were 
then  discussed,  and,  with  slight  modification,  accepted 
by  the  Commission.  These  officers  returned  in  June 
to  the  Isthmus,  with  full  authority  to  inaugurate  their 
work  by  selecting  their  personnel  and  providing  their 
supplies. 

The  Commission  returned  to  the  Canal  Zone  early  in 
August,  when  the  necessity  of  immediate  and  perma- 
nent sanitary  organization  was  at  once  apparent.  A 
great  part  of  the  five  weeks  during  which  the  Commis- 
sion remained  there  was  spent  in  conference  with  the 
heads  of  that  department,  after  their  experience  of 
three  months,  concerning  the  scope  and  details  of  an 
organization  which  should  give  them  all  necessary 
authority  and  opportunity  to  perform  their  most  impor- 
tant duty.  The  discussion  was  full  and  free  and  resulted 
in  the  adoption  of  the  project,  which  forms  part  of  the 
minutes  of  the  Commission  for  August  28,  1904.  It 
was  the  clear  understanding  at  the  time,  and  has  been 
since,  that  this  scheme  of  organization  was  satisfactory. 


36 

not  only  to  the  Commission,  but  to  the  officers  upon 
whom  the  responsibility  for  the  sanitation  of  the  Isth- 
mus devolved.  Since  that  time,  much  correspondence 
on  sanitary  subjects  has  passed  and  many  interviews 
with  members  of  the  Sanitary  Staff  have  been  held,  but 
the  Commission  has  not  learned  from  either  source  that 
the  plan  of  organization  has  failed  or  has  become  un- 
acceptable to  those  charged  with  its  execution.  Nota- 
bly, a  committee  of  the  Commission,  recently  returned 
from  the  Isthmus,  unreservedly  states  the  full  satisfac- 
tion of  the  Sanitary  Staff  with  the  successful  operation 
of  the  organization  and  the  health  conditions  on  the 
Isthmus. 

Of  course,  during  the  inception  of  this  great  work, 
there  have  been  occasions  when  the  filling  of  requisi- 
tions has  been  delayed,  or  where  other  annoyances  have 
temporarily  existed,  but  the  Commission  has  no  reason 
to  believe  that  the  scheme  of  sanitary  administration 
has  not  been  wisely  devised,  or  that  it  has  not  been 
effective  in  operation. 

The  Commission  understands  the  immense  impor- 
tance of  the  sanitation  of  the  Isthmus  as  a  factor  in  the 
building  of  the  canal.  It  is  certain  that  the  Chiefs  of  the 
Sanitary  Department  are  aware  of  the  grave  responsi- 
bility resting  upon  them.  If  the  statements  of  Dr. 
Reed  were  true,  either  in  detail  or  in  the  general  im- 
pression they  are  intended  to  convey  of  sanitary  condi- 
tions on  the  Isthmus,  they  would  convict  the  Sanitary 
Staff  of  a  gross  abandonment  of  duty  in  failure  to  in- 
form the  Commission  thereof.  Neither  from  official 
conferences,  nor  from  correspondence,  nor  from  inter- 
views with  members  of  the  Staff,  has  it  been  learned 
that  the  plan  is  defective  in  scope  or  elasticity,  or  that 
troubles  have  occurred,  except  such  as  inevitably  attend 
the  organization  of  great  enterprises. 


37 

It  remains  to  be  stated  that  the  action  of  the  Com- 
mission as  expressed  in  its  reports,  and  in  the  resolutions 
found  in  the  record  of  its  proceedings,  is  to  be  accepted 
as  the  action  of  the  Commission,  and  represents  a  con- 
sensus of  opinion  often  arrived  at  before  a  report  or  a 
resolution  was  written.  The  fact  that  any  Commis- 
sioner may  have  been  more  frequently  noted  than 
others  as  presenting  resolutions,  is  no  reason  why 
greater  responsibility  for  the  Commission's  action 
should  fall  upon  him  than  upon  the  other  Commis- 
sioners. 

In  conclusion,  the  Commission  desires  to  express  its 
appreciation  of  the  courtesy  of  your  act  in  giving  it 
early  opportunity  to  file  a  reply  to  the  letter  of  Dr. 
Reed. 

The  report  of  Dr.  Reed  was  transmitted  to  this  Com- 
mission by  you  as  a  confidential  document.  The  Com- 
mission has  learned,  however,  that  within  the  last  few 
days  it  has  appeared,  in  full,  in  the  Journal  of  the  Amer- 
ican Medical  Association,  published  in  Chicago,  and 
that  synopses  thereof  have  been  published  in  a  num- 
ber of  newspapers.  The  Commission  would,  therefore, 
most  respectfully  suggest  that  this  reply  be  not  treated 
as  a  confidential  document,  but  that  a  copy  thereof  be 
transmitted,  with  a  request  for  publication  in  full,  to 
the  Journal  of  the  American  Medical  Association,  and 
that  the  public  press  be  requested  to  give  it  extended 
notice. 

Very  respectfully, 

J.  G.  Walker,  Chairman; 
Wm.  Barclay  Parsons, 
Wm.  H.  Burr, 

B.  M.  Harrod, 

C.  E.  Grunsky. 


38. 

Isthmian  Canal  Commission, 
Washington,,  D.  C,  March  i8,  1905. 

Hon.  Wm.  H.  Taft,  Secretary  of  War,  Washington,  D.  C. 

Sir: 

The  Commission  desires,  in  addition  to  the  reply  to 
Dr.  C.  A.  L.  Reed,  forwarded  to  you  on  March  17th,  to 
call  attention  to  the  Doctor's  charge  that  *'The  re- 
sponsibility for  the  present  existence  of  yellow  fever  on 
the  Isthmus  can  be  placed  no  where  else  than  upon  the 
Isthmian  Canal  Commission." 

This  charge  is  sufficiently  refuted  by  the  following 
extracts  from  a  letter  addressed  to  the  Governor  of  the 
Canal  Zone,  under  date  of  February  ist,  by  Col.  W.  C. 
Gorgas,  the  Chief  Sanitary  Officer  of  the  Commission: 

*'In  answer  to  conversation  with  yourself  this  morn- 
ing and  enclosed  extract  from  letter  of  the  Secretary  of 
War,  I  desire  to  state  that  I  do  not  think  the  delays  in 
getting  medical  supplies  on  the  Isthmus  have  had  any- 
thing whatever  to  do  with  the  yellow  fever  at  present 
in  Panama.  ...  I  would  also  like  to  state  that 
there  is  every  evidence  that  the  work  is  being  entirely 
successful,  just  as  it  was  in  Havana.  Of  course,  I  am 
referring  entirely  to  the  yellow  fever  work." 
Very   respectfully, 

J.  G.  Walker, 

Chairman. 

Washington,  D,  C,  March  2,  1905. 
Honorable  William  H.  Taft,  Secretary  of  War. 

Dear  Sir  : 

Pursuant  to  your  request  I  have  the  honor  herewith 
to  submit  the  report  of  my  observations  relative  to  the 
status  of  sanitation  and  of  the  Sanitary  Department  in 
the  Canal  Zone  and  in  the  Cities  of  Colon  and  Panama. 

I  arrived  at  Colon  on  the  7th  of  Febuary  and  sailed 


39 

from  that  city  on  the  226.  of  the  same  month,  thus 
affording  me  fifteen  days  in  which  to  study,  with  more 
or  less  care,  the  conditions  of  organization  and  the  de- 
tails of  administration  as  they  relate  to  the  public  health 
interest. 

I  was  given  every  facility  in  this  regard  by  General 
Davis,  the  Governor  of  the  Zone;  by  Mr.  Wallace,  the- 
Chief  Engineer;  by  Colonel  Gorgas,  the  Chief  Sanitary 
Officer;  as  well  as  by  his  associates,  Major  La  Garde, 
Lieutenant  Lyster  and  Dr.  Carter.  As  a  result  of  this 
investigation  I  became  impressed  with  the  efficiency 
and  the  zeal  of  the  Sanitary  Staff;  with  the  fact  that 
very  much  has  been  accomplished  in  the  way  of  sanita- 
tion under  exceedingly  adverse  circumstances;  that 
much  remains  to  be  done  which  cannot  be  done  unless 
better  facilities  are  afforded;  and  that  very  much  more 
ought  to  be  done  and  would  have  been  done  if  the  facili- 
had  been  properly  furnished. 

I  was  forced  to  this  conclusion  not  only  by  what  I 
saw  and  heard  while  on  the  Isthmus,  but  by  a  careful 
study  of  the  published  proceedings  of  the  Isthmian 
Canal  Commission,  by  a  study  of  the  laws  of  the  Canal 
Zone  formulated  by  that  Commission,  and  by  a  careful 
consideration  of  their  first  annual  report,  submitted 
under  date  of  December  i,  1904. 

The  situation  became  all  the  more  impressive  from 
the  fact  that  the  question  of  sanitation  on  the  Isthmus 
was  considered  of  so  much  importance  that  it  was  made 
a  subject  of  special  provision  in  the  Canal  Convention 
entered  into  between  the  Republic  of  Panama  and  the 
United  States.  There  is,  in  fact,  no  stipulated  cession 
to  the  United  States  that  does  not  carry  with  it  the 
expressed  right  of  sanitation.  This  is  true  not  only  of 
the  Zone  proper,  but  it  is  likewise  agreed  "That  the 


40 

Cities  of  Panama  and  Colon,"  which  lie  outside  of  the 
Canal  Zone,  ''shall  comply  in  perpetuity  with  the  sani- 
tary ordinances,  whether  of  a  preventive  or  curative 
character,  prescribed  by  the  United  States,  and  in  case 
the  Government  of  Panama,  is  unable  or  fails  in  its  duty 
to  enforce  this  compliance  by  the  Cities  of  Panama  and 
Colon  with  the  sanitary  ordinances  of  the  United  States, 
the  Republic  of  Panama  grants  to  the  United  States 
the  right  and  authority  to  enforce  the  same." 

This  provision  of  treaty  entered  into  by  the  two  coun- 
tries was  the  logical  result  of  the  disastrous  experiences, 
first,  of  the  Panama  Railroad  under  the  three  companies 
that  were  successively  identified  with  its  construction, 
and  later  by  the  two  French  companies  that  had  at- 
tempted to  dig  the  canal.  That  sanitation  was,  indeed, 
the  fundamental  problem  to  be  solved  before  even  the 
engineering  question  could  be  subjected  to  successful 
solution  had  been  reduced  to  a  demonstration. 

This  view  of  the  case  was  manifestly  accepted  by  the 
President,  who,  on  the  formal  installation  of  the  Isth- 
mian Canal  Commission,  addressed  that  body,  in  part, 
as  follows: 

''There  is  one  matter  to  which  I  wish  to  ask  your 
special  attention — the  question  of  sanitation  and 
hygiene.  You  will  take  measures  to  secure  the  best 
medical  experts  for  this  purpose  whom  you  can  obtain, 
and  you  will,  of  course,  make  the  contractors  submit  as 
implicitly  as  your  own  employes  to  all  the  rules  and 
regulations  of  the  medical  department  under  you.  / 
presume  you  will  find  it  best  to  have  one  head  for  this  medi- 
cal department,  but  that  I  shall  leave  to  your  own  judg- 


The  italics  by  the  writer  indicate  the  views  of  the 
President,   subsequently  expressed  to  the  writer,   that 


41 

by  having  Colonel  Gorgas  placed  in  full  charge  of  the 
sanitary  work,  instead  of  on  the  Commission  itself,  as 
had  been  urged  by  the  medical  profession  of  the  United 
States,  he  would  be  untrammeled  with  extraneous 
duties,  and  would  consequently  have  better  opportunity 
to  make  his  work  effective  than  if  he  were  actually  a 
member  of  the  executive  board. 

THE   ORGANIZATION    OF   THE   HEALTH    DEPARTMENT. 

At  the  meeting  of  the  Commission,  held  at  Ancon, 
August  28,  1904,  Mr.  Grunsky,  as  the  Committee  on  the 
proposed  Health  Department,  presented  a  report  which 
began  by  stating  that  "after  repeated  conferences  with'* 
Colonel  Gorgas  and  practically  the  entire  sanitary 
staff,  "it  has  been  agreed,"  but  which  should  have 
stated  that  "in  certain  important  particulars  Mr.  Grun- 
sky has  agreed  with  himself  ;'*  for  as  a  matter  of  fact 
much  of  the  report  was  formulated  over  the  respectful 
protest  of  the  medical  men  who  were  invited  to  the 
conference.  By  this  report  the  Commission,  more 
especially  Mr.  Grunsky,  provided  for  the  creation  of  a 
board  of  health,  with  power  to  formulate  regulations 
which  would  become  effective  only  after  approval  by 
the  Commission,  or  in  cases  of  emergency  only  on  the 
approval  of  the  Governor  of  the  Canal  Zone.  The  Chief 
Sanitary  Officer  was  sent  to  the  Zone  to  clear  it  up  and 
to  make  it  ready  for  the  actual  work  of  the  engineers. 
Thus,  however,  his  discretion  was  limited  to  the  en- 
forcement of  regulations  that  had  first  been  adopted  by 
the  Commission  or  by  a  Board  of  Health;  in  which  lat- 
ter event  it  had  to  be  sent  generally  to  Washington  to 
be  endorsed  by  the  Commission,  or  in  cases  of  emer- 
gency it  had  to  receive  the  approval  of  the  Governor 
of  the  Zone. 


42 

It  thus  came  about  that  the  Chief  Sanitary  Officer, 
whom  and  whose  department  the  medical  profession 
had  asked  to  be  made  largely  autonomous;  whom  and 
which  the  President  himself  had  obviously  intended 
should  be  largely  autonomous,  was  by  the  action  of 
the  Commission,  more  especially  Mr.  Grunsky,  subordi- 
nated to  the  Governor  of  the  Zone;  to  the  Chief  Dis- 
bursing Officer;  to  the  Chief  of  the  Bureau  of  Material 
and  Supplies;  to  Mr.  Grunsky;  to  the  Commission;  to 
the  Secretary  of  War;  to  the  President;  subordinated, 
in  fact,  in  the  seventh  degree  from  the  original  source 
of  authority.  And  this  is  the  state  of  affairs  on  the 
Isthmus  to-day.  One  cannot  but  be  impressed  with  the 
anomalous  condition  by  which  a  man  of  Colonel  Gor- 
gas'  distinction,  the  foremost  authority  in  the  world  in 
solving  the  peculiar  problems  that  are  connected  with 
sanitation  on  the  Isthmus,  being  made  an  instrument  of 
a  whole  series  of  men  who  confessedly  are  ignorant  of 
the  very  questions  with  which  he  is  most  familiar. 

THE  SANITARY  DEPARTMENT  DENIED  THE  RIGHT  TO  DECIDE 
UPON  THE  SUITABILITY  OF  ITS  OWN  SUPPLIES. 

The  Commission  at  Ancon  last  August  adopted  a 
resolution  creating  a  department  of  the  Zone  Govern- 
ment to  be  known  as  the  Material  and  Supplies  Depart- 
ment, the  chief  of  which  is  ''charged  with  the  receipt, 
inspection  on  the  Isthmus,  custody,  care,  shipment, 
transfer,  issue  and  disposition  of  all  supplies,  material, 
equipage  and  floating  equipment  unissued  and  not  in 
actual  use."  It  is,  however,  specifically  provided  that 
**the  Governor  of  the  Canal  Zone,  acting  for  the  Execu- 
tive Branch  of  the  Government  of  the  Zone,  and  the 
Chief  Engineer,  acting  for  the  Department  of  Engineer- 
ing and  Construction,  shall  have  authority  to  decide  on 


43 

the  suitability  of  any  and  all  supplies  furnished,  and 
their  requisitions  for  such  materials  as  are  on  the  Isth- 
mus shall  be  promptly  filled  without  reference  to  a 
higher  authority." 

There  is  nothing  said  about  the  Sanitary  Department, 
and  as  that  which  is  not  included  is  excluded,  it  follows 
that  the  right  very  justly  accorded  to  the  Engineering 
Department  is  denied  to  the  Sanitary  Department  as 
such.  It  is  obvious,  of  course,  that  the  Sanitary  Depart- 
ment, being  made  subordinate  to  "the  Executive 
Branch  of  the  Government  of  the  Zone,"  can  get  sup- 
plies, but  subject  only  to  the  judgment  of  the  Governor, 
who  by  this  resolution  is  empowered  to  pass  upon  the 
suitability  of  any  or  all  supplies  for  the  Medical  Depart- 
ment or  the  Department  of  Public  Health." 

An  example  of  the  working  of  this  rule  was  shown 
in  the  recent  purchase  of  an  X-ray  outfit  for  the  Ancon 
Hospital.  The  requisition  went  in  several  months  ago 
and  was  pending  before  the  Commission,  more  espe- 
cially Mr.  Grunsky,  when  the  expert,  who  had  been 
specially  employed  to  do  X-ray  work  in  Ancon,  hap- 
pened in  Washington  and  requested  the  privilege  of 
selecting  the  Crookes'  tubes;  the  request  was  perempto- 
rily refused;  the  expert  urged  that  his  knowledge  would 
enable  him  to  make  better  selections  than  would  be 
probable  by  an  unskilled  purchasing  agent,  and  went  so 
far  as  to  urge  as  an  additional  reason  the  distance  to  the 
Isthmus,  the  time  involved  in  transportation,  to  say 
nothing  of  the  expense  involved,  only,  however,  to  be 
informed  that  if  the  tubes  did  not  suit  they  could  be 
returned.  They  came  after  a  long  delay;  were  found 
worthless  and  were  returned;  other  ones  have  not  yet 
been  sent  to  replace  them,  and,  as  a  consequence,  An- 
con Hospital  is  to-day  without  X-ray  service,  while  the 


44 

salary  of  the  expert  goes  on.  In  another  instance 
objectives  for  a  number  of  microscopes  were  carefully 
specified  by  the  chief  of  the  laboratory,  who  would 
naturally  be  presumed  to  know  most  about  them,  but 
the  Commission,  more  especially  Mr.  Grunsky,  assumed 
to  possess  superior  knowledge  of  the  subject,  and  sub- 
stituted others,  with  the  result  that  when  they  arrived 
upon  the  Isthmus  they,  too,  were  found  to  be  worthless. 
The  foregoing  are  but  two  examples  of  what  is  con- 
stantly occurring.  The  matter  becomes  really  very 
serious  when  it  involves  questions  of  medicines,  and  in 
this  particular  furnishes  a  strange  inconsistency  with 
the  laws  laid  down  by  the  Commission  for  the  govern- 
ment of  everybody  else  but  themselves.  Thus,  by  the 
laws  of  the  Canal  Zone,  a  severe  penalty  is  imposed 
upon  druggists  and  purveyors  in  general  for  substitut- 
ing one  medicine  for  another  that  may  have  been 
ordered,  yet  instance  after  instance  is  coming  to  the 
front  in  which  the  Commission,  either  through  Mr. 
Grunsky  or  through  an  unqualified  purchasing  agent, 
is  foisting  upon  the  medical  service  remedies  other  than 
those  specified  in  the  requisitions.  This,  I  believe,  holds 
true  in  practically  every  requisition  for  medicine  that 
has  reached  Ancon  Hospital,  and  the  same  principle 
may  probably  account  for  the  fact  that  the  majority  of 
all  of  the  requisitions  for  medical  supplies  have  been 
either  ignored  or  suppressed  by  the  Commission  at 
Washington. 

CHEAP  DOCTORS   FOR  THE  ISTHMUS. 

The  Commission  in  every  effort  that  it  has  made  to 
secure  service  upon  the  Isthmus  has  tacitly  acknowl- 
edged the  unhealthfulness  of  the  region  by  holding  out 
as  an  inducement  that  fact  that  employes  will  be  fur- 


45 

nished  free  medical  service,  including  the  service  of  the 
hospitals.    The  fact  that  medical  men  in  the  Zone  v^ould 
have  much  executive  v^ork  to  do ;  that  they  would  have 
to  deal  with  large  bodies  of  workmen,  and  that  their 
duties  would  require  the  exercise  of  trained  judgment 
in  a  very  broad  sense  prompted  Colonel  Gorgas  to  ad- 
vise that  only  relatively  mature  men  be  brought  to  the 
Isthmus   in   the   capacity   of   physicians.      He   advised, 
furthermore,  that  the  minimum  salary  to  be  paid  to 
medical  men  in  the  Zone  be  the  same  as  the  minimum 
salary  paid  in  the  Army  for  contract  surgeons,  namely, 
$i,8oo.     This  plan  did  not,  however,  commend  itself  to 
the  Commission,  more  especially  to  Mr.  Grunsky,  who, 
in  the  interest  of  alleged  economy,  conceived  the  bril- 
liant scheme  of  establishing  interneships  in  the  hospitals 
of  the  Zone,  the  incumbents  to  receive  $50  per  month, 
the  same  salary  that  is  paid  to  nurses.    The  verbal  justi- 
fication of  the  plan  offered  by  Mr.  Grunsky,  and  subse- 
quently adopted  by  the  Commission,  is  that  young  men 
will  thereby  receive  a  preliminary  training  in  tropical 
diseases,  which  is  to  be  accepted  by  them  as  part  pay 
for  their  services,  after  which,  that  is,  after  a  year,  if 
they  so  desire,  they  will  be  at  liberty  to  return  to  the 
States.     But  Mr.  Grunsky  takes  pains  not  to  say  that 
the  incidental  service  to  be  rendered  by  these  internes 
is  to  represent  the  bone  and  sinew  of  the  medical  service 
on  the  Isthmus,  and  likewise  fails  to  make  clear  how  he 
expects  to  establish  a  stable  medical  service  if,  after  the 
expiration  of  a  year,  his  internes  are  at  liberty  to  return 
to  the  North,  which  they  would  doubtless  do  in  the  ab- 
sence of  inducements  to  remain  upon  the  Isthmus.  But 
what  if  they  should  desire  to  return  before  the  end  of  a 
year?     This  question  brings  us  face  to  face  with  Mr. 
Grunsky's  trap  to  get  cheap  medical   service  for  the 


46 

Zone.  Once  upon  the  Isthmus,  these  young  men,  find- 
ing themselves  on  the  salaried  basis  of  nurses,  with 
incidental  expenses  that  cannot  be  evaded  and  that  v^ill 
eat  up  the  last  penny  of  their  beggarly  stipend,  desir- 
ing to  leave  their  humiliating  positions,  v^ill  find  the 
door  closed  against  egress.  It  is  even  to-day  easy  for 
an  employe  to  get  to  the  Isthmus,  but  it  is  already  ex- 
ceedingly difficult  for  him  to  get  away  from  it.  And 
what  is  true  to-day  will  be  more  emphatically  true  in 
the  future,  a  fact  that  the  Commission,  more  especially 
Mr.  Grunsky,  takes  great  care  to  leave  in  the  back- 
ground. But  the  Commission,  more  especially  Mr. 
Grunsky,  holds  up  the  prospect  of  promotion.  This, 
in  any  event,  under  Mr.  Grunsky's  rules,  cannot  be 
granted  under  one  year,  and  then,  if  granted,  which  it 
may  not  be,  the  salary  is  placed  at  $125.00  per  month,  or 
$300.00  per  year  less  than  the  minimum  salary  paid  to 
contract  surgeons  in  the  army.  What  is  there  about  the 
medical  service  in  the  Canal  Zone  that  should  render  it 
less  entitled  to  compensation  than  the  same  medical 
service  when  rendered  in  the  Army?  What  is  there 
about  the  personnel  of  the  Zone  Government;  about 
the  employes;  about  the  laborers  that  they  should  be 
furnished  with  a  cheaper  grade  of  medical  service  than 
the  officers,  soldiers  and  enlisted  men  of  the  Army? 
Why  should  not  the  Commission,  more  especially  Mr. 
Grunsky,  follow  the  example  of  both  the  Army  and  the 
Navy  and  accept  men  who  have  already  served  interne- 
ships  in  the  hospitals  of  the  States,  give  them  decent 
salaries,  and  then,  after  sending  them  to  the  Isthmus, 
give  them  additional  opportunities  for  the  preliminary 
study  of  tropical  diseases  at  the  hospitals  at  Ancon  and 
Colon?  And  why  should  this  not  be  done  at  once,  that 
a  competent  medical  staff  may  be  at  the  Isthmus  when 


47 

the  large  bodies  of  workmen  shall  have  arrived.  This 
could  not  but  be  gratifying  to  the  Chief  Sanitary  Ofifiicer, 
whose  wishes,  however,  it  would  seem  not  only  to  be 
expressed  to  have  them  vetoed  by  the  Commission, 
more  especially  by  Mr,  Grunsky,  in  what  seems  to  be  a 
fatuous  desire,  regardless  of  consequences,  to  give  every 
detail  the  impress  of  his  overpowering  personality. 

THE   commission's   PETTY  ANTAGONISMS  TO   THE  SANITARY 
DEPARTMENT. 

That  the  opinion  just  expressed,  viz.,  that  the  Com- 
mission, more  especially  Mr.  Grunsky,  visits  upon 
Colonel  Gorgas  and  upon  the  Sanitary  Department  not 
only  unnecessary  and  unreasonable  restraints  and  confronts 
it  with  petty,  almost  despicable  antagonisms,  is  shown  by 
reference  to  a  series  of  unrelated  facts.  Thus,  Colonel 
Gorgas  asked  the  Commission  to  invest  him  with  indi- 
vidual authority  in  carrying  out  views  which  had 
matured  not  only  from  his  long  professional  study,  but 
as  a  result  of  his  highly  successful  experience  in  Cuba; 
the  reply  was  the  establishment  of  a  Board  of  Health, 
followed  by  his  subordination  successively,  under  the 
immediate  control  of  practically  every  feature  of  gov- 
ernment in  the  Zone.  He  asked  for  a  department  of 
hospitals,  with  an  officer  at  its  head;  this  was  tempo- 
rarily granted;  but  the  office  was  soon  abolished  and 
was  forced  into  Colonel  Gorgas'  own  office  without  any 
compensatory  addition  to  his  executive  force.  Colonel 
Gorgas  sent  in  numerous  requisitions,  many  of  which, 
as  I  shall  have  occasion  to  allude  more  in  detail,  were 
disregarded;  he  followed  them  with  letters  of  respect- 
ful protest  about  the  slowness  of  receiving  supplies; 
the  reply  was  the  statement  made  to  him  verbally  and 
under  humiliating  surroundings  that  he  was  disrespect- 


48 

ful  to  his  superior  officers.  Colonel  Gorgas  submitted 
an  estimate  for  the  establishment  of  emergency  hos- 
pitals along  the  line.  This  estimate  was  reduced  by 
the  Commission;  Colonel  Gorgas  wanted  to  begin 
drainage  and  other  important  mosquito  work  simulta- 
neously at  other  points  along  the  line,  and  for  this  pur- 
pose asked  for  twenty  inspectors;  the  Commission, 
more  especially  Mr.  Grunsky,  took  the  matter  under 
serious  advisement,  and  reduced  the  estimate  to  eight 
inspectors.  Colonel  Gorgas  asked  for  screens  for  all 
the  buildings  in  the  Zone;  the  Commission,  more  espe- 
cially Mr.  Grunsky,  concluded  that  this  was  a  totally 
unwarranted  expense,  and  eliminated  the  proposition. 
Colonel  Gorgas  then  urged  that  mosquito  screening  be 
furnished  for  all  of  the  buildings  at  the  Ancon  Hospital, 
the  screens  to  be  placed  around  the  galleries ;  the  Com- 
mission, more  especially  Mr.  Grunsky,  concluded,  how- 
ever, that  only  one-half  of  the  gallery  space  ought  to  be 
enclosed;  that  the  windows  might  possibly  be  screened 
with  advantage,  and  that  even  in  that  part  of  the  gal- 
leries where  screening  was  applicable  it  might  be  well 
to  board  up  the  part  of  them  below  the  railing,  utterly 
unmindful  that  such  a  proposition  would  carry  about 
ten  times  the  expense  of  screening.  Colonel  Gorgas 
asked  for  a  chief  clerk  at  $1,800.00,  with  the  object  of 
getting  a  man  who  had  had  experience  with  him  in 
Cuba;  he  was  allowed  only  $1,500.00,  for  which  he  could 
get  only  an  inexperienced  man.  He  asked  for  $5,000.00 
for  a  health  officer  for  Panama,  a  most  important  office, 
with  the  hope  that  he  might  fill  it  with  a  man  of  Cuban 
experience;  the  Commission,  more  especially  Mr. 
Grunsky,  allowed  $3,000.00,  with  which  it  was  possible 
to  secure  only  the  services  of  a  previously  inexperi- 


49 


enced  man.  Colonel  Gorgas  asked  for  one  hundred 
female  nurses,  duly  qualified  for  service  at  Ancon  and 
Colon  hospitals,  on  a  basis  of  a  normal  bed  capacity  of 
those  two  institutions ;  the  Commission,  more  especially 
Mr.  Grunsky,  replied  by  furnishing  him  forty  female 
nurses,  but  by  authorizing  the  establishment  of  a  train- 
ing school,  by  which,  as  in  the  instance  of  the  interne- 
ships,  it  was  hoped  to  get  the  services  of  inexperienced 
nurses  for  comparatively  little  money.  Colonel  Gorgas 
asked  for  $50.00  per  month  for  trained  men  for  orderlies 
in  the  hospitals ;  it  would  be  impossible  to  get  them  for 
less  money.  The  Commission,  more  especially  Mr. 
Grunsky,  replied  by  cutting  the  allowance  down  to 
$25.00  per  month  for  the  trained  wardmen  and  $15.00 
per  month  for  orderlies,  with  the  result  that  the  medical 
staff  is  being  subjected  to  serious  confusion  by  the  inef- 
ficiency of  the  natives,  who  alone  will  accept  these  small 
wages.  Colonel  Gorgas  recommended  to  the  Commis- 
sion the  prompt  control  of  both  Colon  and  Panama,  to 
which  I  shall  have  subsequent  occasion  to  allude;  the 
Commission,  more  especially  Mr.  Grunsky,  found  a  con- 
venient pretext  in  totally  imaginary  diplomatic  com- 
plications to  defer  this  step  until  forced  to  it  by  the 
development  of  yellow  fever.  Colonel  Gorgas  recom- 
mended a  sysem  of  movable  latrines,  which  is  used  in 
the  larger  labor  camps  as  a  preventive  of  ankylosto- 
miasis or  hook-worm,  with  which  the  natives  are 
already  infected,  and  which  is  one  of  the  most  pestilen- 
tial diseases  of  the  tropics;  the  Commission  did  not 
consider  this,  only  one  member  of  which  taking  any 
notice  of  the  suggestion,  and  that  to  the  extent  of  ex- 
pressing his  disapproval,  coupling  with  his  disapproval 
the  suggestion  that  in  certain  tropical  countries  with 


50 

which  he  is  familiar  hogs  and  buzzards  have  been  suc- 
cessfully relied  upon  to  dispose  of  night-soil.  Colonel 
Gorgas  asked  in  his  original  scheme  that  the  institution 
at  Taboga  be  set  aside  for  the  accommodation  of  con- 
convalescents  from  the  hospitals  at  Ancon,  and  at  other 
points  in  the  Zone,  and  asked  for  the  privilege  to  nomi- 
nate a  doctor  and  head  nurse  for  the  place  and  to  equip 
the  institution;  the  Commission,  more  especially  Mr. 
Grunsky,  replied  that  while  they  would  repair  the  insti- 
tution they  would  not  put  it  in  commission.  (As  a 
matter  of  fact  some  repairs  have  been  made,  the  institu- 
tion is  now  in  the  charge  of  a  caretaker,  while  the  hos- 
pital at  Ancon  is  overcrowded  with  convalescents  and 
with  the  personnel  of  the  institution,  thus  materially 
reducing  the  real  hospital  capacity  of  the  institution.) 
Colonel  Gorgas  asked  in  November  for  the  personnel 
for  the  hospital  at  Meriflores,  which,  in  accordance  with 
the  understanding  had  with  Secretary  Taft  during  his 
stay  on  the  Isthmus,  was  set  aside  for  the  accommoda- 
tion of  the  insane  and  the  lepers  of  the  Republic;  the 
Commission,  more  especially  Mr.  Grunsky,  authorized 
that  a  doctor  and  an  assistant,  with  a  nurse,  be  transfer- 
red to  the  institution,  but  furnished  no  person  to  take 
the  places  from  which  they  had  been  detached. 
Colonel  Gorgas  asked  that  he  be  given  some  oppor- 
tunity to  exercise  his  judgment  as  to  the  qualifications 
of  the  personnel,  and  as  to  the  quality  of  supplies  to  be 
furnished  his  department;  the  Commission,  more  espe- 
cially Mr.  Grunsky,  declined  to  give  him  this  important 
supervision  over  the  selecton  of  his  personnel,  while  the 
Disbursing  Officer  declined  to  give  him  the  opportunity 
to  inspect  supplies  before  they  were  actually  issued  to 
the  Sanitary  Department.     Colonel  Gorgas  at  the  first 


51 

outbreak  of  yellow  fever  in  July  of  last  year  asked  for  a 
general  appropriation  to  be  disbursed  at  his  discretion 
with  which  to  meet  the  emergency;  the  Commission, 
more  especially  Mr.  Grunsky,  peremptorily  declined  to 
place  any  sum  of  money  at  his  disposal,  and  forced  him 
to  rely  exclusively  upon  the  established  machinery  for 
securing  necessary  supplies.  Colonel  Gorgas  then  asked 
the  privilege  of  ordering  directly  from  the  medical  pur- 
veyor in  New  York  to  the  amount  specifically  of 
$30,000.00,  silver,  for  first  month  of  the  yellow  fever 
epidemic,  and  $15,000.00  for  each  following  month,  so 
long  as  it  might  be  necessary;  the  Commission,  more 
especially  Mr.  Grunsky,  again  refused,  but  directed  that 
the  Bureau  of  Material  and  Supplies  be  ordered  to  pur- 
chase the  necessary  articles,  which  it  assumed  to  do,  but 
notwithstanding  the  lapse  of  eight  months  these  sup- 
plies are  not  yet  upon  the  Isthmus. 

Doors  and  windows  for  the  hospital  at  Culebra  were 
asked  for  in  January,  but  are  not  yet  in  place.  Flooring 
for  the  porch  of  the  hospital  at  Gorgona,  likewise  asked 
for  in  January,  has  not  yet  been  furnished,  and  patients 
have  to  be  carried  up  and  down  stairs  and  through  the 
open  to  get  them  from  one  ward  to  another.  Colonel 
Gorgas  asked  for  screens  for  the  hospitals  along  the  line 
and  sent  in  requisitions  for  the  same  in  July;  the  Com- 
mission, more  especially  Mr.  Grunsky,  concluded  that 
they  were  not  necessary;  Colonel  Gorgas  asked  that  a 
gang  of  men  for  the  purpose  of  making  repairs  be 
placed  at  his  disposal,  and  Chief  Engineer  Wallace  set 
aside  a  number  of  men  for  this  purpose;  the  Commis- 
sion, more  especially  Mr.  Grunsky,  however,  stopped 
this  convenient  arrangement  and  directed  that  here- 
after all  such  things  must  be  done  only  after  estimates 
had  been  previously  submitted;  Colonel  Gorgas  asked 


for  pyrethrum,  sulphur  and  other  materials  for  disinfec- 
tion work — the  request  having  been  sent  in  last  Septem- 
ber; the  Commission,  more  especially  Mr.  Grunsky, 
concluded  the  esimate  was  large,  cut  it  down  to  one- 
fourth  and  then  sent  the  material  only  in  small  lots  from 
time  to  time;  Colonel  Gorgas  requested  that  a  certain 
house  be  constructed  at  the  quarantine  station,  seriously 
needed  for  the  benefit  of  the  service;  the  Commission, 
more  especially  Mr.  Grunsky,  ignored  the  request,  and 
the  service  was  embarrassed  for  the  want  of  necessary 
facilities;  Colonel  Gorgas  asked  for  the  equipment  for 
the  research  laboratory,  and  for  a  small  personnel  at 
an  aggregate  expense  of  fifteen  thousand  dollars 
($15,000.00),  but  an  annual  operating  expense  of  about 
one  hundred  and  forty  dollars  ($140.00),  the  small 
operating  expense  for  salaries  being  attributable  to  the 
fact  that  men  already  connected  with  Ancon  could  be 
detailed  for  the  service;  the  Commission,  more  espe- 
cially Mr.  Grunsky,  supported  in  this  instance  by  Gov- 
ernor Davis,  rendered  an  adverse  decision  on  this  appli- 
cation. Colonel  Gorgas  asked  that  an  ambulance  be 
kept  on  the  ground  at  Ancon  for  prompt  service;  the 
Commission,  more  especially  Mr.  Grunsky,  replied  that 
the  ambulance  must  be  kept  in  the  corral  outside  of  the 
hospital  grounds,  as  a  result  of  which  unnecessary  time 
of  the  Commission  was  consumed  in  alleged  delibera- 
tion over  this  question,  and  as  a  further  result  it  is  im- 
possible to  get  the  ambulance  on  ready  call  at  times  of 
emergency.  These  are  but  a  few  of  the  many  examples 
that  could  be  cited  by  which  the  Commission,  more 
especially  Mr.  Grunsky,  thwarts  the  honest  endeavor  of 
Colonel  Gorgas  to  put  the  Canal  Zone  in  proper  sani- 
tary condition.  There  are,  however,  a  number  of  other 
questions  to  which  I  must  hasten  to  invite  attention. 


53 


THE    UNITED    STATES    IN    CHEAP    COMPETITION    WITH    THE 
MEDICAL  PROFESSION   OF   PANAMA. 

The  course  of  the  Commission  in  its  endeavor  to 
establish  a  cheap  medical  service,  naturally  enough 
made  up  of  cheap  doctors,  v^hich  they  hope  in  the 
future  to  send  to  the  Zone,  is  not  limited  in  its  influence 
and  in  its  pernicious  results  to  the  Zone  itself.  To 
make  this  clear,  however,  it  is  important  to  remember 
that  under  the  truly  remarkable  plan  of  organization  of 
the  Sanitary  Department  devised  by  Mr.  Grunsky, 
adopted  by  the  Commission  and  duly  engrossed  in  the 
laws  of  the  Canal  Zone,  it  is  provided  that  all  persons 
not  employes  of  the  Commission,  but  who  may  be 
"sick  in  the  Canal  Zone  and  in  Colon  and  Panama, 
should  be  admitted  to  the  hospitals,  but  such  persons 
shall  pay  according  to  their  means."  This  practically 
opens  the  hospitals  of  the  Zone  as  private  pay  hospitals 
to  all  the  world,  for  it  would  be  difficult  for  any  sick 
persons  to  come  from  anywhere  and  to  enter  the  Zone 
at  either  end  without  being  sick  in  Colon  and  Panama. 
As  a  matter  of  fact  it  happens  with  increased  frequency 
that  patients,  not  only  from  Panama,  but  from  various 
points  along  the  coast  and  in  the  interior,  are  received 
and  treated  in  the  hospitals  at  Ancon.  I  have  no 
knowledge  touching  this  point  at  Colon,  but  can  see  no 
reason  why  it  should  not  be  equally  true.  The  thing, 
however,  would  not  seem  so  bad  if  the  provision  that 
these  patients  should  pay  according  to  their  means  had 
been  permitted  to  stand  without  qualification.  Unfor- 
tunately, however,  the  Commission,  more  especially 
Mr.  Grunsky,  with  his  fondness  for  prescribed  details, 
proceeded  to  lay  down  a  per  diem  charge  for  room  and 
for  nursing  at  Ancon;  the  rates  being  about  the  same 


54 

as  those  charged  for  similar  service  in  the  better  hos- 
pitals of  the  United  States.     He,  however,  did  not  stop 
at  this  point,  but  made  it  a  part  of  the  laws  of  the 
Canal  Zone  that  ''surgical  operations  shall  be  charged 
for   according   to    their   importance   and   the   financial 
ability  of  the  patient  to  pay,  but  no  charge  in  excess 
of  fifty  dollars  ($50.00)  shall  be  made  without  the  ap- 
proval of  the  Director  of  Hospitals."     As  the  office  of 
Director  of  Hospitals  has  been  abolished,  the  maximum 
rate  to  be  charged  for  surgical  operations,  without  ref- 
erence to  their  gravity,   stands  at  fifty  dollars.     It   is 
furthermore  provided  by  Mr.  Grunsky,  and  made  part 
of  the  laws   of  the   Canal   Zone,   that  physicians   con- 
nected with  the  hospitals  must  visit  the  residences  of 
persons  ''entitled  to  treatment  at  the  hospital,  at  a  fixed 
daily  rate  of  pay,"  which  visits  "shall  be  charged  for  at 
the  rate  of  one-half  dollar  ($.50)  for  each  visit,  but  no 
such  charge  is  to  be  made  for  emergency  calls  nor  in 
the  cases  of  persons  entitled  to  free  hospital  treatment 
until  after  the  person  has  been  ordered  into  the  hos- 
pital."    These  rates,  which  in  the  instance  of  surgical 
operations   vary  from   one-fourth   to   one-tenth   of  the 
average  charge  in  the  United  States  and  in  the  Republic 
of  Panama;  and  in  the  instance  of  visits,  less  than  one- 
fourth  of  the  ordinary  rates  charged  in  the  two  coun- 
tries, cannot  but  be  disgusting  to  the  medical  profession 
in  the  States  who  are  not  in  the  least  influenced  by  the 
belittling   competition.     It   is    important,    however,    to 
bear  in  mind  that  the  physicians  at  Ancon  are  in  no 
sense  the  beneficiaries  of  the  extra  revenue  that  is  thus 
derived  by  extra  service  that  is  imposed  upon  them. 
On  the   contrary,   it  is   provided   by  the   Commission, 
more  especially  by  Mr.  Grunsky,  and  duly  engrossed  in 
the  laws  of  the  Canal  Zone  that  "the  money  realized 


in  the  hospitals  from  charges  for  board,  medical  attend- 
ance, surgical  operations  and  the  like,  and  from  visits 
at  residences  as  set  forth,  shall  be  considered  public 
funds  and  turned  over  to  the  Government  of  the  Canal 
Zone."  It  follov^s,  therefore,  that  it  is  not  the  medical 
men  sent  to  the  Canal  Zone,  but  the  United  States,  our 
own  great  nation  itself,  that  is  engaged  in  this  belittling 
business  which  must  be  recognized  as  a  personal  insult 
to  any  decent  practitioner  of  medicine  in  any  country 
of  the  world.  In  the  Republic  of  Panama  it  amounts 
to  more  than  an  insult;  it  is  an  actual  damage. 

This  was  brought  to  my  attention  by  one  of  the  most 
distinguished  members  of  the  medical  profession  of  that 
country,  who  has  made  me  aware  of  the  situation,  and 
who  did  so  in  terms  of  bitter  complaint.  He  explained 
that  under  the  operation  of  this  order  of  things,  and  in 
spite  of  the  existence  of  other  hospitals  in  Panama,  pri- 
vate patients,  attracted  by  the  cheap  rates  and  the  pres- 
tige of  the  medical  staff  at  Ancon,  are  flocking  to  that 
institution,  to  the  present  serious  embarrassment  and 
prospective  ruin  of  medical  practitioners. 

I  took  the  liberty  to  mention  the  matter  in  the  course 
of  a  personal  interview  with  President  Amador,  himself 
the  most  distinguished  medical  practitioner  of  the  Re- 
public. As  he  is  a  friend  of  long  standing,  I  had  no 
hesitancy  in  securing  from  him  a  very  frank  expression 
of  fact  that  the  subject  had  become  so  serious  that  he 
had  been  waited  upon  by  his  colleagues  of  the  medical 
profession,  his  constituents  and  fellow-citizens,  by 
whom  he  had  been  requested  to  make  formal  represent- 
ations of  the  subject  to  the  American  Minister,  but  that 
he  had  desisted  out  of  his  great  desire  to  avoid  even  the 
semblance  of  friction  with  the  United  States  and  in  the 
belief   that   a   question   so   flagrant   of   injustice   would 


56 

sooner  or  later  reach  executive  circles  in  Washington 
and  be  corrected. 

WHY  IS  THERE  YELLOW  FEVER  IN   PANAMA? 

Yellow  fever  is  demonstrably  a  preventable  disease, 
and,  as  a  consequence,  all  deaths  resulting  from  yellow 
fever  must  at  once  raise  the  question  of  responsibility. 
Panama  has  long  and  justly  been  recognized  as  a  seat 
of  yellow  fever  infection,  just  as  was  Havana  before  the 
brilliant  sanitary  achievements  of  Colonel  Gorgas  in 
that  city — achievements  which  resulted  in  his  call  to  the 
Isthmus.  The  real  campaign  against  the  disease  in 
Havana,  more  particularly  against  the  disease-bearing 
mosquitoes,  lasted  from  January  to  September,  1901. 
As  Panama  is  but  a  village  in  comparison  with  the  Cu- 
ban metropolis,  it  was  naturally  expected  that  similarly 
satisfactory  results  would  be  realized  there  in  the  same, 
if  not  less,  time,  but  yellow  fever  is  still  endemic  in 
Panama.     Why  is  this  true? 

The  dangers  of  the  situation  were  thoroughly  appre- 
ciated by  Colonel  Gorgas  even  before  he  went  to  the 
Isthmus,  and  he  laid  a  plan  of  campaign  before  the  Com- 
mission which  embraced  several  distinct  features, 
namely: 

1.  The  installation  of  a  sewer  system  in  the  cities  of 
Colon  and  Panama. 

2.  The  installation  of  water  supply  in  those  cities. 

3.  The  cleaning  of  the  streets,  including  the  disposal 
of  garbage  and  night  soil. 

4.  General  sanitation  of  houses,  including  their  fumi- 
gation, and  the  drainage  of  neighboring  pools,  the  abo- 
lition of  water  barrels  and  cisterns  and  other  places  for 
the  propagation  of  the  yellow  fever  mosquito. 

5.  The  prompt  isolation  of  all  cases  of  yellow  fever. 


57 

These  various  steps  bore  such  a  logical  relation  to 
each  other  that  one  would  become  practically  inopera- 
tive vi^ithout  the  other. 

This  viev^  v^as  apparently  accepted  by  the  Commis- 
sion, even  including  Mr.  Grunsky,  before  the  first  visit 
of  that  body  to  the  Isthmus,  and  it  was  likewise  the  view 
still  of  Colonel  Gorgas  and  the  entire  personnel  of  the 
Sanitary  Department,  as  well  as  of  Mr.  Wallace,  the 
head  of  the  Engineering  Department,  when  on  June 
28th  full  sanitary  government  was  established  in  the 
Canal  Zone.  Panama  was  then  apparently  free  from 
yellow  fever,  and  Colonel  Gorgas,  with  his  Cuban  ex- 
perience, and  knowing  the  danger  that  was  lurking  in 
the  immediate  future,  set  about  promoting  complete 
measures  of  prevention,  while  Mr.  Wallace  addressed 
himself  to  plans  and  specifications  for  water  works  and 
a  sewer  system  for  Panama.  The  plans  of  both  of 
these  men  went  promptly  before  the  Commission,  but 
it  was  not  until  that  body  had  returned  to  the  Isthmus 
in  August  following  that  they  were  given  serious  con- 
sideration; meanwhile  the  danger  of  which  Colonel 
Gorgas  had  forewarned  them  had  developed,  for  on 
July  12  Charles  Cunningham  was  stricken  with  yellow 
fever,  from  which  he  died  two  days  later.  Fourteen 
days  after  this  death  another  case  developed,  which, 
however,  went  on  to  recovery.  When  the  Commission 
arrived  at  Ancon  on  the  occasion  of  its  second  visit — 
that  is,  on  August  3rd — Colonel  Gorgas  again  urged 
the  prompt  assumption  of  control  over  Colon  and  Pan- 
ama, and  cited  the  case  still  in  the  hospital  and  the  fatal 
one  that  had  preceded  it  as  danger  signals  of  sufficient 
gravity  to  justify  action.  But  the  Commission,  more 
especially  Mr.  Grunsky,  had  not  yet  determined  the 
degree  of  humiliating  subordination  to  which  the  Sani- 


S8 

tary  Department  was  to  be  subjected,  under  pretext 
of  perfecting  a  plan  of  organization,  deferred  action  for 
another  three  and  one-half  weeks — valuable  weeks — 
that  is,  until  August  28th.  On  this  date  the  Commis- 
sion, on  the  report  of  Mr.  Grunsky,  adopted  Mr.  Grun- 
sky's  plan  of  organization,  by  which,  as  I  have  already 
shown.  Colonel  Gorgas  was  subordinated  to  the  seventh 
degree  below  the  original  source  of  authority,  and  even 
then,  with  cases  of  yellow  fever  staring  them  in  the  face, 
the  Commission,  at  the  instance  of  Mr.  Grunsky,  di- 
rected Colonel  Gorgas,  acting  through  Governor  Davis, 
to  refrain  from  any  attempt  to  secure  sanitary  control 
over  the  cities  of  Colon  and  Panama,  citing  certain  more 
or  less  diplomatic  frivolities  as  a  pretext  for  deferred 
action.  It  was  only  after  four  more  months  had  elapsed, 
only  after  the  progressive  development  of  yellow  fever 
had  reached  the  sensational  point,  and  only  after  the 
personnel  in  the  Canal  Zone  had  become  thoroughly 
alarmed  over  the  situation,  that  Colonel  Gorgas  was 
permitted  by  those  in  authority  over  him  to  assume  the 
sanitary  control  of  the  two  cities,  one  of  which,  Panama, 
being  already  very  generally  infected. 

But  even  then  his  hands  were  tied.  Sometimes,  and 
in  important  particulars,  by  the  arbitrary  exercise  of 
super-imposed  authority,  but  all  the  time,  and  in  still 
more  important  particulars,  by  the  fact  that  the  water 
supply  and  the  sewage  system  were  not  installed.  Mr. 
Wallace  had  drawn  the  plans  and  specifications  in  July 
previous,  and  had  taken  care  to  specify  only  such  pipe 
as  manufacturers  keep  in  stock,  and  that  could,  there- 
fore, be  procured  without  a  moment's  delay.  But  the 
Commission,  more  especially  Mr.  Grunsky,  in  total 
disregard  of  the  emergency  that  was  present,  saw  fit  to 
indulge  in  some  views  about  pipe,  and  as  Mr.  Grunsky 
is  a  civil  engineer,  and  needed  to  impress  that  fact  upon 


59 

somebody,  he  summoned  Mr.  Wallace,  now  his  sub- 
ordinate, before  the  Commission  to  explain  why  he  had 
specified  both  Eastern  and  Western  standards  of  pipes. 
The  explanation  given  by  Mr.  Wallace  that  either  one 
or  both  these  standards  would  answer  the  purpose,  and 
that  it  had  been  simply  his  desire  to  get  the  pipe 
promptly  upon  the  Isthmus,  seemed  to  make  no  appeal 
to  either  the  Commission  or  Mr.  Grunsky,  and  pipe  of 
the  Western  pattern  alone  was  ordered.  The  delay 
upon  this  particular  point  consumed  another  precious 
two  weeks,  when  Mr.  Wallace  was  authorized  to  pro- 
ceed with  the  work.  This  he  undertook  with  his  char- 
acteristic energy,  and,  allowing  for  all  reasonable  delay 
in  procuring  the  pipe  and  in  sending  it  to  the  Isthmus, 
promised  the  people  of  Panama  that  they  should  have 
water  by  December.  He  finished  the  work  at  the  Rio 
Grande  reservoir;  the  trenches  for  the  pipe  were  dug, 
washed  full  of  dirt  and  re-dug,  but  still  there  was  no 
pipe.  Mr.  Wallace  then  cabled  to  Washington  urging 
that  the  pipe  be  sent,  only,  however,  to  receive  a  repri- 
mand from  Admiral  Walker,  Chairman  of  the  Com- 
mission, admonishing  him  that  cablegrams  from  the 
Isthmus  were  expensive.  It  is  now  nearly  the  ist  of 
March,  and  the  schooner  which  brought  the  first  con- 
signment of  pipe,  not  enough  to  complete  the  work  at 
Panama,  was  discharging  the  cargo  at  Colon  as  I  left. 
It  is  further  understood  that  before  the  work  can  go  on 
this  same  schooner  must  sail  back  to  Mobile,  await  the 
arrival  there  of  enough  pipe  to  make  a  full  cargo,  then 
sail  back  to  Colon  and  again  unload,  a  proceeding  that, 
at  a  conservative  estimate,  will  consume  at  least  from 
two  to  three  more  months.  And  all  this  by  a  Commis- 
sion that  controls  a  line  of  steamers  plying  weekly  be- 
tween New  York  and  the  Isthmus! 

In  the  light  of  all  these  facts,  in  contrast  with  the 


6o 


brilliant  results  achieved  by  Colonel  Gorgas  in  Havana, 
the  responsibilty  for  the  present  existence  of  yellow 
fever  on  the  Isthmus  can  be  placed  nowhere  else  than 
upon  the  Isthmian  Canal  Commission,  more  especially 
upon  Mr.  Grunsky. 

THE   CAMPAIGN  AGAINST   MALARIA   THWARTED   BY  THE 
COMMISSION. 

But  sensational  as  is  yellow  fever,  now  apparently 
on  the  increase  at  the  Isthmus,  the  fact  remains  that 
malaria  is  the  more  serious  pest.  The  discovery  that 
malaria  is  disseminated  by  the  anopheles  has,  however, 
made  it  possible  to  minimize  the  disease  by  proper  pre- 
ventive methods.  These  embrace  (a)  drainage,  (b)  the 
isolation  of  malarial  patients,  (c)  prophylactic  cinchon- 
ism.  That  these  three  things  might  be  done,  and  done 
before  the  onset  of  the  dry  season,  Colonel  Gorgas 
asked  the  Commission  last  August  to  furnish  men  to  dig 
ditches  and  drain  pools  about  the  houses  of  natives. 
He  asked  also  for  wire  screening  with  which  to  isolate 
all  patients  afiflicted  with  malaria,  and  quinine  with 
which  mildly  to  cinchonize  laborers  and  others  exposed 
to  the  malaria-bearing  mosquitoes.  The  Commission, 
more  especially  Mr.  Grunsky,  however,  thought  that 
the  number  of  ditches  asked  for — something  like  twen- 
ty— was  too  many,  and  allowed  only  half  those  esti- 
mated; but  as  the  dry  season  has  arrived  and  is  almost 
past,  and  as  the  small  squad  of  ditchers  is  still  digging, 
it  would  seem  that  the  original  estimate  was  justified 
by  the  necessities  of  the  situation.  The  wire  screening 
was  likewise  cut  down  from  2,500  yards  to  500  yards, 
and  even  that  has  not  yet  arrived  upon  the  Isthmus. 
The  use  of  quinine  as  a  preventive  of  infection  did  not 
commend  itself  either  to  the  great  therapeutic  skill  or 


6i 


to  the  economic  judgment  of  the  Commission,  more 
especially  Mr.  Grunsky,  so  the  observation  of  medical 
men  on  the  Isthmus,  the  conclusions  of  authorities  in 
tropical  medicine,  such  as  Munson  and  Giles,  the  inves- 
tigations of  the  Italian  authorities,  and  the  unequivocal 
verdict  of  Koch,  were  pushed  aside,  and  quinine  for 
this  purpose  was  stricken  from  the  list.  The  result  is 
that  while  much  has  been  accomplished  by  drainage, 
and  by  the  admission  of  small  fish  into  the  runnels  made 
by  the  small  force  of  workmen,  and  while  much  has 
been  accomplished  by  the  prophylactic  use  of  quinine 
by  the  personnel  and  employes  of  the  higher  grades, 
and  taken  by  them  in  spite  of  the  action  of  the  Com- 
mission, the  fact  remains  that  in  the  absence  of  the  wire 
screening  ordered  last  August,  each  case  of  malaria  be- 
comes a  focus  for  the  further  dissemination  of  the  dis- 
ease. This  is  shown  even  at  the  Ancon  Hospital,  where 
in  the  absence  of  wire  screening  for  the  malarial  wards 
and  the  consequent  impossibility  of  excluding  the  ma- 
laria-bearing mosquitoes,  non-malarious  patients  are 
becoming  malarious,  while  white  nurses  and  attendants 
are  being  made  frequent  victims  of  the  disease.  Two 
members  of  the  medical  staff  likewise  were  suffering 
from  malarial  infection  during  the  time  of  my  stay  at 
Ancon,  yet  in  spite  of  these  facts  the  Isthmian  Canal 
Commission,  in  its  report  under  date  of  December,  1904, 
page  88,  states  that  "All  cases  of  employes  sick  with 
malaria  are  taken  into  the  Colon  and  Ancon  hospitals 
and  so  screened  that  mosquitoes  cannot  reach  them" — a 
statement  that  is  an  absolute  and  an  unqualified  false- 
hood. 

CHEAP  NURSING  SERVICE. 

This  report  might  be  indefinitely  amplified,  but  time 
will  not  permit.  I  feel  it  important,  however,  to  allude 


62 


to  the  fact  that  the  policy  that  the  Commission,  more 
especially  Mr.  Grunsky,  has  adopted  with  reference  to 
furnishing  cheap  medical  service  to  those  who  risk  their 
lives  in  the  Zone  has  been  adopted  for  the  purpose  of 
furnishing  nurses  for  service  in  the  Sanitary  Depart- 
ment. The  effort  has  been  made  under  the  subterfuge 
of  the  training  school  to  be  conducted  at  Ancon,  to  get 
nurses  to  go  to  the  Zone  at  about  the  same  rate  that  is 
paid  for  pupil  nurses  in  the  training  schools  of  the 
United  States.  The  same  conditions  practically  are  im- 
posed upon  the  nurses  with  reference  to  time  service 
as  is  imposed  upon  the  internes,  with  the  difference, 
however,  that  the  period  of  enforced  detention  upon 
the  Isthmus  under  contract  is  placed  at  three  years. 
This  is  not  a  place  to  take  untrained  nurses  under  any 
pretext,  for  nothing  but  fully  developed  talent  in  the 
various  departments  of  activity  should  be  sent  to  the 
Isthmus. 

CONCLUSION. 

In  view  of  the  foregoing  facts,  and  disregarding 
equally  serious  facts  relating  to  the  Department  of  En- 
gineering and  Construction  upon  which  I  do  not  feel 
qualified  or  authorized  to  report,  I  beg  leave  to  call 
attention  to  the  further  observations  of  the  President 
when  he  inducted  the  Commission  into  office,  as  fol- 
lows: i    .      . 

"I  believe  that  each  one  of  you  will  serve  not  merely 
with  entire  fidelity,  but  with  the  utmost  efficiency.  If 
at  any  time  I  feel  that  any  one  of  you  is  not  rendering 
the  best  service  which  it  is  possible  to  procure,  I  shall 
feel  called  upon  to  disregard  alike  my  feelings  for  the 
man  and  the  man's  own  feelings,  and  forthwith  to  sub- 
stitute for  him  on  the  Commission  some  other  man 
whom  I  deem  capable  of  rendering  better  service." 


63 

I  have  the  honor  not  only  to  submit  the  suggestion, 
but  really  to  urge  the  view  that  the  time  has  arrived 
when  the  President  ought  to* redeem  his  word  and  ask 
for  the  resignation  of  the  Commission. 
I  have  the  honor  to  be 

Very  respectfully, 

Charles  A.  L.  Reed. 
President,   Committee   on  Medical  Legislation,  American 
Medical  Association. 


OF  THE 

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\?.  LIBRARY 


